Suchy Christian, Berger Moritz, Steinbrück Ingo, Oyama Tsuneo, Yahagi Naohisa, Dumoulin Franz Ludwig
Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of Bonn, Bonn, Germany.
Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany.
Endosc Int Open. 2021 Feb;9(2):E258-E262. doi: 10.1055/a-1321-1271. Epub 2021 Feb 3.
We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15-6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.
我们之前报道了我们最初的182例大肠内镜黏膜下剥离术（ESD）的病例系列。在最初的系列中，155例ESD在技术上是可行的，其中137例整块切除，97例切缘阴性的整块切除（R0）。在此，我们展示长期随访数据，特别关注未实现整块切除或整块切除导致切缘阳性（R1）的病例。2012年9月至2015年10月期间，我们对178例患者连续进行了182例ESD手术（中位大小41.0±17.4mm；部位：直肠与直肠近端分别为63例与119例）。随访数据来自我们的内镜数据库和转诊医生。在最初的队列中，11例患者接受了手术；其余171例中的141例（82.5%）有随访数据，中位随访时间为2.43年（范围0.15 - 6.53年）。8例患者观察到复发性腺瘤（切缘阳性的整块ESD术后2例；分片切除术后6例）。无论切缘情况如何，整块切除后的复发率较低（1.8%对18.2%；P<0.01）。所有复发均为低级别腺瘤，可通过内镜处理。整块ESD术后复发率较低，尤其是如果能实现完整切除。分片切除后的复发率与已发表的关于黏膜分片切除的数据相当。
