Chen Alex, Chen Michael, Trepanier Maude, Siblini Aya, Mueller Carmen, Cools-Lartigue Jonathan, Spicer Jonathan, Ferri Lorenzo
Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
J Gastrointest Surg. 2020 Nov;24(11):2456-2465. doi: 10.1007/s11605-020-04791-4. Epub 2020 Sep 16.
Organ-sparing endoscopic submucosal dissection (ESD) is an acceptable treatment strategy for superficial neoplastic lesions of the esophagus and stomach. The adoption of this technique has lagged in North America compared with Asia, and we sought to report on our experiences with ESD for upper GI neoplasia.
A prospectively entered database of all patients undergoing endoscopic resection of esophageal and gastric neoplasia at McGill University from 2009 to 2019 was queried for those who received ESD.
A total of 103 consecutive ESDs were identified from 2009 to 2019. Seventy-one (69%) patients were male and the median age was 72 (range: 38-90). Sixty-one (59%) cases were esophageal and 42 (41%) gastric. Forty-nine (48%) were performed in the endoscopy suite under local sedation only. Perforation occurred in 9 patients (7 esophageal and 2 stomach), of which 3 required operative repair. Histology was principally invasive carcinoma (79, 77%), with 17 (16%) dysplastic lesions (e.g., HGD), 1 (1%) neuroendocrine tumor, and 7 (7%) benign lesions. En bloc resection was achieved in 90 (87%), and the complete resection rate was 74 (72%), with 51 (50%) of procedures fulfilling the criteria for curative resection. At medium of 23-month (2-199) follow-up of these 51 curative resections, one case of recurrent carcinoma was found at follow-up and was managed with repeat endoscopic resection. Non-curative ESDs were found 45 (R1 resection = 29: risk of lymph node metastasis = 16), 21 had active surveillance, and 24 were resected.
ESD is a viable, effective, and safe therapeutic and staging modality for superficial lesions of the stomach and esophagus.
保留器官的内镜黏膜下剥离术（ESD）是治疗食管和胃浅表性肿瘤病变的一种可接受的治疗策略。与亚洲相比，北美地区该技术的应用较为滞后，我们旨在报告我们应用ESD治疗上消化道肿瘤的经验。
查询了2009年至2019年在麦吉尔大学接受食管和胃肿瘤内镜切除的所有患者的前瞻性录入数据库，以找出接受ESD治疗的患者。
2009年至2019年共确定了103例连续的ESD病例。71例（69%）患者为男性，中位年龄为72岁（范围：38 - 90岁）。61例（59%）为食管病变，42例（41%）为胃病变。49例（48%）仅在局部麻醉下在内镜检查室进行。9例患者发生穿孔（7例食管穿孔和2例胃穿孔），其中3例需要手术修复。组织学检查主要为浸润性癌（79例，77%），17例（16%）为发育异常病变（如高级别上皮内瘤变），1例（1%）为神经内分泌肿瘤，7例（7%）为良性病变。90例（87%）实现了整块切除，完整切除率为74例（72%），其中51例（50%）手术符合根治性切除标准。对这51例根治性切除病例进行了平均23个月（2 - 199个月）的随访，随访中发现1例复发性癌，经再次内镜切除处理。45例非根治性ESD（R1切除 = 29例：有淋巴结转移风险 = 16例），21例进行了主动监测，24例进行了再次切除。
ESD是治疗胃和食管浅表病变的一种可行、有效且安全的治疗和分期方法。
