内镜黏膜下剥离术治疗十二指肠黏膜上皮浅表肿瘤相关穿孔的处理。

Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors.

机构信息

Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.

出版信息

Gastrointest Endosc. 2020 May;91(5):1129-1137. doi: 10.1016/j.gie.2019.09.024. Epub 2019 Sep 26.

DOI:10.1016/j.gie.2019.09.024

PMID:31563595

Abstract

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) is being performed more frequently as a local treatment for superficial duodenal epithelial tumors (SDETs). However, ESD for SDETs is technically difficult because of specific anatomic features that increase the risk of perforation and often require surgery. This study was performed to evaluate the management of ESD-related perforation in patients with SDETs.

METHODS

Patients who underwent ESD for SDETs from July 2010 to December 2018 were studied. We collected data on complete closure, insertion of endoscopic nasobiliary and pancreatic duct drainage (ENBPD) tubes, and additional interventions. We also evaluated clinical outcomes, including the fasting period, hospital stay, and maximum serum C-reactive protein level.

RESULTS

ESD was completed in 264 patients with SDETs. Perforation was observed in 36 patients, including 4 patients with delayed perforation. Among 32 patients with intraoperative perforation, complete closure was achieved in 13 patients. Compared with patients without complete closure, the fasting period and hospital stay were significantly shorter and the maximum serum C-reactive protein level was significantly lower in patients with complete closure, which were equivalent to those in patients without perforation. In patients without complete closure for mucosal defect, no additional interventions were required when an ENBPD tube was inserted, whereas 2 patients without ENBPD tube insertion underwent additional interventions such as percutaneous drainage and a surgical operation.

CONCLUSIONS

Perforation associated with ESD for SDETs required complex conservative management with complete closure or insertion of an ENBPD tube.

摘要

背景与目的

内镜黏膜下剥离术（ESD）作为治疗浅层十二指肠上皮肿瘤（SDETs）的局部治疗方法，应用日益增多。然而，由于特定的解剖学特征增加了穿孔的风险，且往往需要手术，因此 SDETs 的 ESD 技术难度较大。本研究旨在评估 SDETs 患者 ESD 相关穿孔的处理方法。

方法

回顾性分析 2010 年 7 月至 2018 年 12 月期间接受 ESD 治疗的 SDETs 患者的临床资料。收集完全封闭、内镜鼻胆管和胰管引流（ENBPD）管插入以及其他干预措施的数据。评估临床结局，包括禁食期、住院时间和血清 C 反应蛋白（CRP）的最高水平。

结果

264 例 SDETs 患者完成了 ESD。36 例患者发生穿孔，其中 4 例为迟发性穿孔。32 例术中穿孔患者中，13 例患者实现了完全封闭。与未完全封闭的患者相比，完全封闭患者的禁食期和住院时间明显缩短，血清 CRP 最高水平明显降低，与未穿孔患者相当。对于黏膜缺损未完全封闭的患者，当插入 ENBPD 管时无需进行其他干预，而未插入 ENBPD 管的 2 例患者需要进行经皮引流和手术等其他干预。