巴西两家转诊医院的内镜黏膜下剥离术治疗胃浅表性肿瘤：日本和韩国的结果能否与之相媲美？

Endoscopic submucosal dissection for superficial gastric neoplasias in two referral hospitals in Brazil: Can the Japanese and South Korean results be equaled?

机构信息

Unidad de Endoscopia, Instituto Alfa de Gastroenterología, Facultad de Medicina, Universidad Federal de Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Minas Gerais, Brazil.

Servicio de Gastroenterología Clínica San Pablo, Surco, Lima, Peru, Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Miembro de la Sociedad de Gastroenterología del Perú, Lima, Peru.

出版信息

Rev Gastroenterol Mex (Engl Ed). 2021 Jul-Sep;86(3):244-252. doi: 10.1016/j.rgmxen.2021.05.006. Epub 2021 May 21.

DOI:10.1016/j.rgmxen.2021.05.006

PMID:34210458

Abstract

INTRODUCTION AND AIMS

Endoscopic submucosal dissection (ESD) in the treatment of superficial neoplasias of the gastrointestinal tract is currently one of the greatest advances in therapeutic endoscopy. Due to its high technical complexity, it is not yet a routine procedure in Latin America. The aim of the present study was to present the experience in Brazil with ESD in superficial gastric neoplasias, based on training received from Japanese experts.

MATERIALS AND METHODS

A retrospective study was conducted, in which information was prospectively collected from a database that included all patients that underwent ESD due to superficial gastric neoplasias at two endoscopy referral centers in Brazil, within the time frame of June 2008 to June 2019. En bloc, complete, and curative resection rates were calculated, along with the local recurrence rate and adverse events.

RESULTS

A total of 103 ESDs for superficial gastric neoplasias were performed during the study period. Eighty of those patients (77.6%) presented with early malignant gastric neoplasias or premalignant lesions (adenocarcinoma: 52.5%, high-grade dysplasia: 27.5%, low-grade dysplasia: 16.3%, and neuroendocrine tumors: 3.8%). Overall en bloc and complete resection rates for the superficial gastric neoplasias were 96.3% and 92.5%, respectively, whereas the curative resection rate based on expanded criteria was 76%.

CONCLUSIONS

ESD for the treatment of superficial gastric neoplasias is a safe and effective therapeutic modality in Latin America, with results similar to those shown in the most representative Japanese studies.

摘要

介绍和目的

内镜黏膜下剥离术（ESD）治疗胃肠道表浅性肿瘤是治疗内镜学的重大进展之一。由于其技术复杂性高，在拉丁美洲尚未成为常规治疗方法。本研究旨在基于日本专家的培训，介绍巴西在胃表浅性肿瘤的 ESD 治疗方面的经验。

材料和方法

这是一项回顾性研究，从巴西两个内镜转诊中心的数据库中前瞻性收集了所有因胃表浅性肿瘤而接受 ESD 治疗的患者信息，时间范围为 2008 年 6 月至 2019 年 6 月。计算了整块、完全和治愈性切除率，以及局部复发率和不良事件。

结果

研究期间共进行了 103 例胃表浅性肿瘤的 ESD。其中 80 例（77.6%）患者为早期恶性胃肿瘤或癌前病变（腺癌：52.5%，高级别异型增生：27.5%，低级别异型增生：16.3%，神经内分泌肿瘤：3.8%）。胃表浅性肿瘤的整块和完全切除率分别为 96.3%和 92.5%，而基于扩展标准的治愈性切除率为 76%。