Santos-Antunes João, Marques Margarida, Morais Rui, Baldaque-Silva Francisco, Vilas-Boas Filipe, Moutinho-Ribeiro Pedro, Lopes Susana, Carneiro Fátima, Macedo Guilherme
Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo).
Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal (João Santos-Antunes).
Ann Gastroenterol. 2022 Jan-Feb;35(1):68-73. doi: 10.20524/aog.2021.0675. Epub 2021 Nov 10.
Use of endoscopic submucosal dissection (ESD) for the diagnosis and treatment of subepithelial lesions (SELs) is limited in the West, and the best approach for these lesions is still debated. In this study we describe our experience regarding the usefulness, safety and outcomes of ESD for SELs.
We performed a retrospective analysis of ESD in the diagnosis and treatment of SELs between November 2010 and February 2021.
A total of 634 ESDs were reviewed. Fifty-five (9%) were performed in SELs, 6 in the esophagus, 34 in the stomach, and 15 in the rectum. ESD was technically successful in 53 lesions (96%). Most of them (82%) had previous endoscopic ultrasound evaluation, but only 20% had a histological diagnosis previous to the ESD. Neuroendocrine tumors, gastrointestinal stromal tumors, and granular cell tumors accounted for 38% of the procedures, with a 100% rate of resection and 65% of R0 resection; the main criterion for non-curative resection was a deep positive margin, and none of the patients treated with complementary surgery had lesions on the gastrointestinal wall. Most of the procedures (62%) were performed in lesions with very low malignant potential, providing the definitive diagnosis of SELs where the previous diagnostic workup was inconclusive. We had a total of 2 delayed bleedings and 1 perforation, all treated endoscopically.
Our real-life experience showed that ESD can be an effective and safe diagnostic tool for undetermined SELs, as well as an effective treatment for neoplastic SELs with malignant potential.
在西方，内镜黏膜下剥离术（ESD）用于诊断和治疗上皮下病变（SELs）的应用有限，对于这些病变的最佳治疗方法仍存在争议。在本研究中，我们描述了ESD治疗SELs的有效性、安全性及结果方面的经验。
我们对2010年11月至2021年2月期间ESD诊断和治疗SELs的情况进行了回顾性分析。
共回顾了634例ESD。其中55例（9%）用于SELs，6例在食管，34例在胃，15例在直肠。ESD在53个病变中技术成功（96%）。其中大多数（82%）曾接受过内镜超声评估，但只有20%在ESD前有组织学诊断。神经内分泌肿瘤、胃肠道间质瘤和颗粒细胞瘤占手术的38%，切除率为100%，R0切除率为65%；非根治性切除的主要标准是切缘深部阳性，接受补充手术治疗的患者在胃肠道壁上均无病变。大多数手术（62%）针对恶性潜能极低的病变进行，在先前诊断检查结果不明确的情况下提供了SELs的明确诊断。我们共有2例延迟出血和1例穿孔，均通过内镜治疗。
我们的实际经验表明，ESD对于未明确的SELs可以是一种有效且安全的诊断工具，对于具有恶性潜能的肿瘤性SELs也是一种有效的治疗方法。
