内镜黏膜下剥离术在门诊环境下用于切除大肠大型肿瘤：瑞典单中心 660 例系列研究。
Endoscopic submucosal dissection for removal of large colorectal neoplasias in an outpatient setting: a single-center series of 660 procedures in Sweden.
机构信息
Department of Surgery and Urology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
出版信息
Gastrointest Endosc. 2022 Jul;96(1):101-107. doi: 10.1016/j.gie.2022.02.017. Epub 2022 Feb 22.
BACKGROUND AND AIMS
Endoscopic submucosal dissection (ESD) is a technique developed in Japan for the removal of large lesions in the GI tract. Because of the complexity of the technique, implementation in Western health care has been slow. An ESD procedure is usually followed by hospital admission. Our aim was to investigate if ESD of colorectal lesions can be performed in an outpatient setting.
METHODS
Six hundred sixty colorectal ESD procedures between 2014 and 2020 were evaluated retrospectively. All patients referred to the unit with an early colorectal neoplasm >20 mm without signs of deep invasion were considered eligible for an ESD procedure.
RESULTS
Of 660 lesions, 323 (48.9%) were localized in the proximal colon, 102 (15.5%) in the distal colon, and 235 (35.6%) in the rectum. Median lesion size was 38 mm (interquartile range, 30-50) and median procedure duration 70 minutes (interquartile range, 45-115). En-bloc resection was achieved in 620 cases (93.9%). R0 resection was achieved in 492 en-bloc resections (79.4%), whereas the number of Rx and R1 resections was 124 (20.0%) and 4 (.6%), respectively. Low-grade dysplasia was found in 473 cases (71.7%), high-grade dysplasia in 144 (21.8%), and adenocarcinoma in 34 (5.1%). Six hundred twelve procedures (92.7%) were scheduled as outpatient, and 33 of these underwent unplanned admission. Forty-eight cases (7.3%) were planned as inpatient procedures. The rate of full wall perforation was 38 (5.8%), in which 35 (92.1%) were managed endoscopically and 3 patients (7.9%) required emergency surgery. Forty-six patients (7.0%) sought medical attention within 30 days because of bleeding (21 [3.2%]), abdominal tenderness (16 [2.4%]), and other reasons (9 [1.4%]). Twenty-four of these patients were admitted for observation for a median of 2 days (range, 1-7). Ten of these patients were treated with antibiotics, and 6 patients required blood transfusion. None required additional surgery.
CONCLUSIONS
ESD of colorectal lesions can be safely performed in an outpatient setting in a well-selected patient.
背景与目的
内镜黏膜下剥离术（ESD）是日本开发的一种用于切除胃肠道内较大病变的技术。由于该技术较为复杂，在西方医疗保健领域的实施较为缓慢。ESD 手术后通常需要住院。我们的目的是研究是否可以在门诊环境下进行结直肠病变的 ESD。
方法
回顾性评估了 2014 年至 2020 年间的 660 例结直肠 ESD 手术。所有被转诊至该单位的、直径大于 20mm 的早期结直肠肿瘤且无深层浸润迹象的患者均被认为有资格进行 ESD 手术。
结果
660 个病灶中，323 个（48.9%）位于近端结肠，102 个（15.5%）位于远端结肠，235 个（35.6%）位于直肠。病灶中位大小为 38mm（四分位距 30-50），中位手术时间为 70 分钟（四分位距 45-115）。620 例（93.9%）达到整块切除。620 例整块切除中，492 例（79.4%）达到 R0 切除，124 例（20.0%）和 4 例（0.6%）为 Rx 和 R1 切除。473 例（71.7%）为低级别上皮内瘤变，144 例（21.8%）为高级别上皮内瘤变，34 例（5.1%）为腺癌。612 例（92.7%）计划为门诊手术，其中 33 例需要非计划性住院。33 例计划为门诊手术中，48 例（7.3%）为住院手术。全层穿孔的发生率为 38 例（5.8%），其中 35 例（92.1%）经内镜治疗，3 例（7.9%）需紧急手术。46 例（7.0%）在 30 天内因出血（21 例[3.2%]）、腹痛（16 例[2.4%]）和其他原因（9 例[1.4%]）寻求医疗关注。其中 24 例患者因观察需要住院，中位时间为 2 天（范围，1-7）。10 例患者接受了抗生素治疗，6 例患者需要输血。均无需进一步手术。
结论
在精心选择的患者中，结直肠病变的 ESD 可以安全地在门诊环境下进行。
Zotero 插件