Sooltangos Aisha, Davenport Matthew, McGrath Stephen, Vickers Jonathan, Senapati Siba, Akhtar Kurshid, George Regi, Ang Yeng
Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom.
Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom.
World J Gastrointest Endosc. 2017 Dec 16;9(12):561-570. doi: 10.4253/wjge.v9.i12.561.
To investigate the efficacy of endoscopic submucosal dissection (ESD) at diagnosing and treating superficial neoplastic lesions of the stomach in a United Kingdom Caucasian population.
Data of patients treated with or considered for ESD at a tertiary referral center in the United Kingdom were retrieved for a period of 2 years (May 2015 to June 2017) from the electronic patient records of the hospital. Only Caucasian patients were included. Primary outcomes were curative resection (CR) and were defined as ESD resections with clear horizontal and vertical margin and an absence of lympho-vascular invasion, poor differentiation and submucosal involvement on histological evaluation of the resected specimen. Secondary end-points were reversal of dysplasia at 12 mo endoscopic follow-up and/or at the latest follow up. Change in histological diagnosis pre and post ESD was also analysed.
Twenty-four patients were initially identified with intention to treat. 19 patients were eligible after mapping gastroscopy and ESD was attempted on a total of 25 ESD lesions, 4 of which failed and had to be aborted mid-procedure. Out of 21 ESD performed, en-bloc resection was achieved in 71.4% of cases. Resection was considered complete on endoscopy in 90.5% of cases compared to only 38.1% on histology. A total of 6 resections were considered curative (28%), 5 non-curative (24%) and 10 indefinite for CR or non-CR (24%). ESD changed the histological diagnosis in 66.6% of cases post ESD. Endoscopic follow-up in the "indefinite" group and CR group showed that 50% and 80% of patients were clear of dysplasia at the latest follow-up respectively; 2 cases of recurrence were observed in the "indefinite"group. Survival rate for the entire cohort was 91.7%.
This study provides early evidence for the efficacy of ESD as a therapeutic and diagnostic intervention in Caucasian populations and supports its application in the United Kingdom.
探讨内镜黏膜下剥离术（ESD）在诊断和治疗英国白种人群胃浅表性肿瘤病变中的疗效。
从英国一家三级转诊中心的电子病历中检索2年（2015年5月至2017年6月）期间接受ESD治疗或考虑接受ESD治疗的患者数据。仅纳入白种人患者。主要结局为根治性切除（CR），定义为ESD切除标本的水平和垂直切缘清晰，且组织学评估无淋巴管侵犯、低分化和黏膜下浸润。次要终点为内镜随访12个月和/或最新随访时发育异常的逆转。还分析了ESD前后组织学诊断的变化。
最初确定24例患者拟进行治疗。经胃镜检查后，19例患者符合条件，共对25个ESD病变尝试进行ESD，其中4例失败，手术过程中不得不中止。在21例成功进行的ESD中，71.4%的病例实现了整块切除。90.5%的病例在内镜检查时认为切除完整，而在组织学检查中仅为38.1%。共有6例切除被认为是根治性的（28%），5例非根治性的（24%）和10例CR或非CR不确定的（24%）。66.6%的病例ESD后组织学诊断发生了改变。“不确定”组和CR组的内镜随访显示，分别有最新随访时50%和80%的患者发育异常消失；“不确定”组观察到2例复发。整个队列的生存率为91.7%。
本研究为ESD作为白种人群的治疗和诊断干预措施的疗效提供了早期证据，并支持其在英国的应用。
