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一名患有前驱病变并接受7年内镜监测患者发生多发性早期胃癌的风险：病例报告

Risk of multiple early gastric cancers in a patient with precursor lesions and endoscopic surveillance for 7 years: A case report.

作者信息

Pan Hui, Fang Chaoying, He Liping, Li Houqiang, Liu Lanzai, Wang Chao, Chen Jiansu

机构信息

Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch.

Gastrointestinal Endoscopy Center, Fujian Provincial Hospital.

出版信息

Medicine (Baltimore). 2019 May;98(22):e15686. doi: 10.1097/MD.0000000000015686.

DOI:10.1097/MD.0000000000015686
PMID:31145282
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6708962/
Abstract

RATIONALE

Severe mucosal atrophy or intestinal metaplasia is a risk factor for synchronous and metachronous intestinal gastric cancer. Magnifying endoscopy with narrow-band imaging was useful for assessing differentiated early gastric cancer (EGC).

PATIENT CONCERNS

A 62-year-old Chinese female was diagnosed with 5 multiple EGCs or high-grade dysplasia (HGD) with endoscopic surveillance for 7 years.

DIAGNOSES

Synchronous and metachronous multiple EGCs.

INTERVENTIONS

Endoscopic submucosal dissection (ESD) with en bloc resection was performed for all 5 multiple lesions. The ESD specimens were pathologically diagnosed with adenocarcinoma confined to the mucosa or HGD.

OUTCOMES

After endoscopy resection, no residual, recurrent, or synchronous lesions were detected by endoscopic surveillance after ESD.

LESSONS

Long-term, meticulous endoscopic surveillance is needed to monitor risk factors associated with multiple EGCs in patients with severe mucosal atrophy or intestinal metaplasia despite successful Helicobacter pylori eradication.

摘要

理论依据

严重的黏膜萎缩或肠化生是同时性和异时性肠型胃癌的危险因素。窄带成像放大内镜检查有助于评估分化型早期胃癌（EGC）。

患者情况

一名62岁中国女性，经内镜监测7年，被诊断为5处多发EGC或高级别上皮内瘤变（HGD）。

诊断

同时性和异时性多发EGC。

干预措施

对所有5处多发病变均进行了内镜下黏膜剥离术（ESD）整块切除。ESD标本经病理诊断为局限于黏膜层的腺癌或HGD。

结果

内镜切除术后，ESD后内镜监测未发现残留、复发或同时性病变。

经验教训

尽管成功根除幽门螺杆菌，但仍需要长期、细致的内镜监测，以监测严重黏膜萎缩或肠化生患者中与多发EGC相关的危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed1d/6708962/51672add3fe8/medi-98-e15686-g008.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed1d/6708962/7cf33f383937/medi-98-e15686-g006.jpg
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本文引用的文献

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2
Characteristics of Synchronous and Metachronous Multiple Gastric Tumors after Endoscopic Submucosal Dissection of Early Gastric Neoplasm.早期胃肿瘤内镜黏膜下剥离术后同步性和异时性多发胃肿瘤的特征
Clin Endosc. 2018 May;51(3):266-273. doi: 10.5946/ce.2017.109. Epub 2018 Apr 6.
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Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer.
幽门螺杆菌治疗预防胃肿瘤。
N Engl J Med. 2018 Mar 22;378(12):1085-1095. doi: 10.1056/NEJMoa1708423.
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Predictive risk factors associated with synchronous multiple early gastric cancer.与同步性多灶早期胃癌相关的预测风险因素。
Medicine (Baltimore). 2017 Jun;96(26):e7088. doi: 10.1097/MD.0000000000007088.
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Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy.内镜下活检钳活检诊断为高级别异型增生的内镜黏膜下剥离术的临床结果
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Effectiveness of Magnifying Narrow-Band Imaging Endoscopy for Differential Diagnosis between the High-Risk Mixed-Type and Low-Risk Simple-Type of Low-Grade, Well-Differentiated Gastric Tubular Adenocarcinoma.放大窄带成像内镜在低级别、高分化胃管状腺癌高危混合型与低危单纯型鉴别诊断中的有效性
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