Gastroenterology Unit, Department of Digestive Disease, S. Orsola-Malpighi Hospital, Bologna, Italy.
Eur Rev Med Pharmacol Sci. 2019 Oct;23(19):8354-8359. doi: 10.26355/eurrev_201910_19146.
Endoscopic submucosal dissection (ESD) is a technique for en bloc resection of neoplastic lesions of the digestive tract. Endoscopic submucosal dissection was developed in Asia, and data from Western countries are scarce. Our study aimed to assess the efficacy and safety of ESD for resection of superficial premalignant and malignant epithelial neoplasms in a tertiary center in Italy.
All patients with gastrointestinal lesions who underwent ESD between January 2013 and December 2018 in our center were retrospectively evaluated. Technical success, en bloc, R0, curative resection, and complication rates were assessed.
A total of 107 lesions (stomach, no.=41; rectum, no.=32; colon, no.=28; esophagus, no.=5; duodenum, no.=1) were resected by ESD in 93 patients. Endoscopic submucosal dissection was technically successful in 99.1% (106/107) of lesions. Among the 90 superficial premalignant and malignant epithelial neoplasms, en bloc, and R0 resection rates were 97.8% (no.=88) and 75.6% (no.=68), respectively. Major complications occurred in 9.3% (10/107) of cases: 4 (3.7%) were perforations and 6 (5.6%) were major bleedings. All complications, but two which needed surgery, were managed endoscopically.
Our study shows that ESD is a feasible, effective, and safe technique in a Western country.
内镜黏膜下剥离术（ESD）是一种整块切除消化道肿瘤性病变的技术。ESD 技术起源于亚洲，西方国家的数据则较为有限。本研究旨在评估内镜黏膜下剥离术在意大利一家三级中心切除胃黏膜上皮浅表性癌前和恶性肿瘤的疗效和安全性。
回顾性分析 2013 年 1 月至 2018 年 12 月期间在我院接受 ESD 的所有胃肠道病变患者。评估技术成功率、整块切除、R0 切除、治愈性切除和并发症发生率。
93 例患者的 107 处病变（胃 41 处，直肠 32 处，结肠 28 处，食管 5 处，十二指肠 1 处）行 ESD 切除。内镜黏膜下剥离术技术成功率为 99.1%（106/107）。在 90 例胃黏膜上皮浅表性癌前和恶性肿瘤中，整块和 R0 切除率分别为 97.8%（88/90）和 75.6%（68/90）。9.3%（10/107）的病例发生主要并发症：穿孔 4 例（3.7%），大出血 6 例（5.6%）。所有并发症，除 2 例需手术外，均经内镜处理。
本研究表明，ESD 是一种在西方国家可行、有效且安全的技术。
