Choi Cheol Woong, Kang Dae Hwan, Kim Hyung Wook, Park Su Bum, Kim Su Jin
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan Korea.
Medicine (Baltimore). 2017 Aug;96(31):e7574. doi: 10.1097/MD.0000000000007574.
Because an esophageal submucosa tumor (SMT) may be malignant despite its small size, a safe endoscopic resection method is needed in some small SMTs. Conventional endoscopic mucosal resection (EMR) may be simple, but incomplete pathologic resection margin status is common. We aimed to investigate the clinical outcomes of 2 kinds of EMR techniques (conventional EMR and EMR with band ligation device) and to evaluate the factors associated with incomplete pathologic resection.We evaluated the medical records of 36 patients. All lesions were esophageal SMTs located in the submucosa or muscularis mucosa less than 10 mm in size by endoscopic ultrasound (EUS). The clinical outcomes based on the endoscopic procedures and factors associated with incomplete pathologic resection were evaluated.The mean tumor size was 6.6 ± 4.1 mm. The overall en bloc and complete resection rates were 100% and 80.6%, respectively. No procedure-related complications, such as perforation and bleeding, were found. Univariate analysis showed that complete resection rates were higher in granular cell tumors than in leiomyomas (82.8% vs 17.2%, P = .029), tumors located in the submucosa layer than in the muscularis mucosa (96.6% vs 3.4%, P = .003), and in EMR with band ligation device than in conventional EMR (82.8% vs 17.2%, P < .001). Multivariate analysis showed that conventional EMR was the only significant factor associated with incomplete resection (OR, 35.594; 95% CI, 2.042-520.329; P = .014)EMR with a band ligation device is an effective and safe treatment method for small esophageal SMT.
由于食管黏膜下肿瘤（SMT）即使体积小也可能是恶性的，因此对于一些小的SMT需要一种安全的内镜切除方法。传统的内镜黏膜切除术（EMR）可能操作简单，但病理切除边缘状态不完全的情况很常见。我们旨在研究两种EMR技术（传统EMR和带结扎装置的EMR）的临床结果，并评估与病理切除不完全相关的因素。我们评估了36例患者的病历。所有病变均为内镜超声（EUS）检查发现的位于黏膜下层或黏膜肌层、大小小于10毫米的食管SMT。评估了基于内镜手术的临床结果以及与病理切除不完全相关的因素。肿瘤平均大小为6.6±4.1毫米。总体整块切除率和完全切除率分别为100%和80.6%。未发现穿孔和出血等与手术相关的并发症。单因素分析显示，颗粒细胞瘤的完全切除率高于平滑肌瘤（82.8%对17.2%，P = 0.029），位于黏膜下层的肿瘤高于黏膜肌层的肿瘤（96.6%对3.4%，P = 0.003），带结扎装置的EMR高于传统EMR（82.8%对17.2%，P < 0.001）。多因素分析显示，传统EMR是与切除不完全相关的唯一显著因素（OR，35.594；95%CI，2.042 - 520.329；P = 0.014）。带结扎装置的EMR是治疗小的食管SMT的一种有效且安全的治疗方法。
