Yu Xinying, Chen Jian, Yuan Zhiqiang, Liu Hui, Liu Fugang, Liu Yong, Xue Liyan, He Shun, Zhang Yueming, Dou Lizhou, Liu Xiao, Zhao Deli, Li Jun, Wang Shaofeng, Zhang Ping, Lu Ning, Wang Guiqi
Department of endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Early diagnosis and treatment of cancer, Feicheng Peoples Hospital, Shandong, China.
Therap Adv Gastroenterol. 2020 Mar 10;13:1756284820909172. doi: 10.1177/1756284820909172. eCollection 2020.
Endoscopic resection cap technique (ER-Cap), multiband mucosectomy (MBM), and endoscopic submucosal dissection (ESD) have been widely applied in the treatment of esophageal squamous neoplasia and cancer. However, little is known with regards to the comparison of these methods. This study aimed to compare the feasibility, safety, effectiveness, and costs of these three techniques.
A retrospective analysis of patients with squamous premalignant or early malignant lesions of the esophagus undergoing ER-Cap, MBM, or ESD from January 2009 to December 2015 in one of the centers in China was performed. The procedural data and follow-up data for all patients were recorded.
A total of 672 patients with 733 lesions were included; 148 lesions (133 patients) were treated with ER-Cap, 427 lesions (388 patients) with MBM, and 158 lesions (151 patients) with ESD. The mean age was 61.59 years and the male-to-female ratio was 2.78:1. The operation time was significantly shorter for ER-Cap (29.26 ± 16.73 mins, < 0.001) group, and the hospitalization costs were significantly lower in the MBM group (20,942.03 ± 8435.56￥, = 0.003). The resection sample size of ESD was significantly larger (4.40 ± 1.20 cm, < 0.001) and the resection rate of ESD was significantly higher ( < 0.001) than that of the other two groups. The frequencies of perforation, bleeding, and cicatricial stenosis were significantly lower in the MBM group ( < 0.001, = 0.011, = 0.009). Three local recurrences were observed in the ER-Cap group, while no recurrence was observed in MBM and ESD groups. There were three and two metastatic patients observed in the MBM and ESD groups, respectively.
ER-Cap, MBM, and ESD are all minimally invasive, safe, and effective methods for treating early esophageal squamous cell carcinoma. MBM could be considered as a good alternative when performed by a less-experienced endoscopist in high-incidence areas with limited resources.
内镜下切除帽技术（ER-Cap）、多环黏膜切除术（MBM）和内镜黏膜下剥离术（ESD）已广泛应用于食管鳞状上皮瘤变和癌症的治疗。然而，关于这些方法的比较了解甚少。本研究旨在比较这三种技术的可行性、安全性、有效性和成本。
对2009年1月至2015年12月在中国某中心接受ER-Cap、MBM或ESD治疗的食管鳞状上皮癌前病变或早期恶性病变患者进行回顾性分析。记录所有患者的手术数据和随访数据。
共纳入672例患者的733个病变；148个病变（133例患者）接受ER-Cap治疗，427个病变（388例患者）接受MBM治疗，158个病变（151例患者）接受ESD治疗。平均年龄为61.59岁，男女比例为2.78:1。ER-Cap组手术时间明显较短（29.26±16.73分钟，<0.001），MBM组住院费用明显较低（20942.03±8435.56元，=0.003）。ESD切除样本大小明显更大（4.40±1.20厘米，<0.001），ESD切除率明显高于其他两组（<0.001）。MBM组穿孔、出血和瘢痕狭窄的发生率明显较低（<0.001，=0.011，=0.009）。ER-Cap组观察到3例局部复发，而MBM组和ESD组未观察到复发。MBM组和ESD组分别观察到3例和2例转移患者。
ER-Cap、MBM和ESD都是治疗早期食管鳞状细胞癌的微创、安全且有效的方法。在资源有限的高发地区，由经验较少的内镜医师进行MBM时，可将其视为一种良好的替代方法。
