Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
BMC Gastroenterol. 2020 May 12;20(1):148. doi: 10.1186/s12876-020-01293-0.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence.
In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.
The en bloc resection rate (32.2% vs. 100%, p < 0.001) and complete resection rate (94.8% vs. 99.0%, p = 0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p = 0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions > 2 cm (p = 0.002) or red in color (p = 0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p < 0.05). In the case of recurrence after endoscopic resection, most of the recurred lesions were removed through additional endoscopic procedures; there was no difference between the two groups (p = 0.153).
The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions > 2 cm or showing redness due to an increased risk of local recurrence and EMR may be possible for low-grade dysplasia that is less than 2 cm without surface changes such as redness, depression and nodularity.
内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）广泛应用于治疗胃上皮异型增生。既往研究比较了早期胃癌内镜切除的临床疗效，但很少有研究单独针对胃异型增生。本研究旨在评估胃上皮异型增生内镜治疗后的长期预后，探讨不同治疗方式下局部复发率的差异，并确定与局部复发相关的危险因素。
本回顾性研究比较了 2011 年 1 月至 2015 年 12 月间 599 例行 EMR 和 306 例行 ESD 治疗的胃上皮异型增生患者的整块切除率（32.2% vs. 100%，p<0.001）、完全切除率（94.8% vs. 99.0%，p=0.003）、局部复发率（1.3% vs. 4.2%，p=0.026）和与局部复发相关的危险因素。
EMR 组的整块切除率（32.2% vs. 100%，p<0.001）和完全切除率（94.8% vs. 99.0%，p=0.003）显著低于 ESD 组。ESD 组的局部复发率（1.3%）显著低于 EMR 组（4.2%；p=0.026）。无论病变位置或组织学分级如何，病变>2cm（p=0.002）或红色（p=0.03）患者的局部复发风险均显著增加。与 EMR 组相比，ESD 组的局部复发率显著降低，完全切除率显著升高（p<0.05）。内镜切除后复发的患者，大多数复发病灶均通过再次内镜治疗切除，两组间无差异（p=0.153）。
与 EMR 相比，ESD 治疗胃上皮异型增生患者的完全切除率显著提高，局部复发率显著降低。因此，对于局部复发风险增加的病变>2cm 或表现为红色的患者，应考虑 ESD 作为首选治疗方法；对于<2cm 且无红色、凹陷和结节等表面改变的低级别异型增生，EMR 可能是可行的。
