两种多波段黏膜切除术装置用于 Barrett 食管相关肿瘤内镜切除的比较。

Comparison of two multiband mucosectomy devices for endoscopic resection of Barrett's esophagus-related neoplasia.

机构信息

Division of Surgery & Interventional Science, University College London (UCL), Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.

Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK.

出版信息

Surg Endosc. 2019 Nov;33(11):3665-3672. doi: 10.1007/s00464-018-06655-0. Epub 2019 Jan 22.

DOI:10.1007/s00464-018-06655-0

PMID:30671663

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6795619/

Abstract

BACKGROUND

Esophageal adenocarcinoma carries a poor prognosis and therefore treatment of early neoplasia arising in the precursor condition Barrett's esophagus (BE) is desirable. Visible lesions arising in BE need endoscopic mucosal resection for accurate staging and removal. Resection modalities include a cap-based system with snare and custom-made multiband mucosectomy (MBM) devices (Duette, Cook Medical Ltd). A new MBM device has recently become available (Captivator, Boston Scientific Ltd).

OBJECTIVES

A retrospective pilot study to compare the efficacy, safety, specimen size and histology of endoscopic mucosal resection (EMR) specimens resected with two MBM devices (Cook Duette and Boston Captivator) in treatment naive patients undergoing endoscopic therapy for BE neoplasia.

METHODS

Consecutive EMR procedures carried out by a single experienced endoscopist were analysed. All visible lesions were marked and resected using one of the two MBM devices. All resected specimens were analysed by the same two experienced pathologists. The resected specimens in both groups were analysed for maximum diameter, minimum diameter, surface area and depth.

RESULTS

Twenty consecutive patients were analysed (18M + 2F; mean age 74) in the Duette group and 20 (17M + 3F; mean age 72) in the Captivator group. A total of 58 specimens were resected in the Duette and 63 in the Captivator group. Min diameter, max diameter, surface area and depth of the ER specimens resected by the Captivator device were significantly larger than that by the Duette device [min diameter 9.89 mm vs 9.07 mm (p = 0.019); max diameter: 13.54 mm vs 12.38 mm (p = 0.024); surface area: 135.40 mm vs 113.89 mm (p = 0.005); depth 3.71 mm vs 2.89 (p = 0.001)].

CONCLUSIONS

These two MBM devices showed equivalent efficacy and safety outcomes, but the EMR Captivator device resected specimens with a larger area in the esophagus when compared with the Duette device. A possible advantage of this is in situations where en bloc resections with fewer EMRs are desirable for larger lesions.

摘要

背景

食管腺癌预后不良，因此治疗巴雷特食管（BE）这种前期病变中的早期肿瘤是理想的。BE 中出现的可见病变需要进行内镜黏膜切除术以进行准确分期和切除。切除方式包括带有圈套器的帽式系统和定制的多环黏膜切除术（MBM）装置（Duette，库克医疗有限公司）。最近出现了一种新的 MBM 装置（Captivator，波士顿科学有限公司）。

目的

一项回顾性试点研究旨在比较两种 MBM 装置（库克 Duette 和波士顿 Captivator）在未经治疗的 BE 肿瘤患者接受内镜治疗时，对内镜黏膜切除术（EMR）标本的疗效、安全性、标本大小和组织学的影响。

方法

对一位经验丰富的内镜医生进行的连续 EMR 手术进行分析。所有可见病变均使用其中一种 MBM 装置进行标记和切除。由两位有经验的病理学家对所有切除的标本进行分析。对两组的切除标本进行最大直径、最小直径、表面积和深度分析。

结果

在 Duette 组中分析了 20 例连续患者（18 例男性+2 例女性；平均年龄 74 岁），在 Captivator 组中分析了 20 例连续患者（17 例男性+3 例女性；平均年龄 72 岁）。Duette 组共切除 58 个标本，Captivator 组切除 63 个标本。Captivator 装置切除的 ER 标本的最小直径、最大直径、表面积和深度明显大于 Duette 装置[最小直径 9.89mm 比 9.07mm（p=0.019）；最大直径：13.54mm 比 12.38mm（p=0.024）；表面积：135.40mm 比 113.89mm（p=0.005）；深度 3.71mm 比 2.89mm（p=0.001）]。