Universidade Federal de Minas Gerais, Faculdade de Medicina, Instituto Alfa de Gastrenterologia, Belo Horizonte, MG, Brasil.
Universidade Federal de São João Del Rei, MG, Brasil.
Arq Gastroenterol. 2021 Apr-Jun;58(2):195-201. doi: 10.1590/S0004-2803.202100000-35.
Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence.
We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T).
Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events.
A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001).
ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms.
内镜黏膜下剥离术（ESD）治疗食管表浅肿瘤，整块切除率高，复发率低。
比较环形切口内镜黏膜下剥离术（ESD-C）与黏膜下隧道内镜黏膜下剥离术（ESD-T）治疗食管表浅肿瘤的效果和临床结局。
回顾性分析 2009 年至 2018 年期间在单中心接受 ESD 治疗的所有食管浅表癌患者的临床资料。ESD-T 定义为经口至肛门方向进行黏膜切开和黏膜下隧道的技术。ESD-C 包括完成环形切口和 ESD。主要研究结果包括整块和 R0 切除率。次要研究结果包括手术特点、治愈性切除率、局部复发和不良事件。
共 65 例患者接受了 ESD 治疗，其中 40 例（61.5%）为食管鳞癌，25 例（38.5%）为 BE 肿瘤。ESD-T 组与 ESD-C 组在整块切除率（91.3%比 100%，P=0.12）、R0 切除率（65.2%比 78.6%，P=0.24）、治愈性切除率（65.2%比 73.8%，P=0.47）和手术时间（118.7 分钟比 102.4 分钟，P=0.35）方面无统计学差异。ESD-T 组和 ESD-C 组的不良事件分别为：出血（0 比 2.4%，P=0.53）、穿孔（4.3%比 0，P=0.61）、食管狭窄（8.7%比 9.5%，P=0.31）。ESD-T 组和 ESD-C 组的局部复发率分别为 8.7%和 2.4%，分别在平均随访 8 年和 2.75 年后发生（P=0.28）。
ESD-T 和 ESD-C 治疗食管表浅肿瘤的效果相当，安全性相似。
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