Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan.
Division of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
J Gastrointestin Liver Dis. 2020 Mar 13;29(1):41-49. doi: 10.15403/jgld-510.
Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis.
This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up.
The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1-60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs.
ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.
内镜黏膜下剥离术（ESD）似乎是一种合理的选择，适用于位于黏膜下层的胃肠道黏膜下上皮下病变（SELs）。ESD 的适应证包括小的神经内分泌肿瘤（NETs）和不确定的 SELs。然而，关于 ESD 和监测的前瞻性数据仍不清楚。本研究旨在前瞻性研究 ESD 的结果，包括器官特异性结果和中期预后。
这项前瞻性多中心研究纳入了 57 例因位于黏膜下层的 SELs 而行 ESD 的患者[明确的 NETs（n=42）和不确定的 SELs（n=15）]。在整个队列和亚组（NETs 和不确定的 SELs）中评估了 ESD 的疗效和安全性。所有患者均接受随访。
整块切除率、根治性切除率和并发症发生率在总体人群（n=57）、NETs（n=42）和不确定的 SELs（n=15）中分别为 98.2%、66.7%和 7.7%、100%、61.9%和 2.4%、93.3%、80.0%和 20.0%。胃（20%，n=5）和十二指肠（33%，n=3）中 NETs 的根治性切除率低于直肠（71%，n=34）。包括 16 例 NETs 患者中的 11 例采用了保守方法导致非根治性切除，在随访期间无患者发生肿瘤复发（中位数，24.5 个月；范围，1-60 个月）。ESD 后监测对非根治性 NETs 显示出可接受的中期结果。
ESD 可作为一种有效的治疗黏膜下层 SELs 的方法。然而，胃和十二指肠 NETs 的 ESD 在根治性和技术方面可能存在局限性。临床医生应注意 ESD 治疗不确定的 SELs 的潜在并发症。
