Wu Zhong-Wei, Ding Chao-Hui, Song Yao-Dong, Cui Zong-Chao, Bi Xiu-Qian, Cheng Bo
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Oncol. 2022 Jul 13;12:967100. doi: 10.3389/fonc.2022.967100. eCollection 2022.
The majority of colon lesions are <10 mm in size and are easily resected by endoscopists with appropriate basic training. Lesions ≥10 mm in size are difficult to remove technically and are associated with higher rates of incomplete resection. Currently, the main endoscopic approaches include endoscopic mucosal resection (EMR) for lesions without submucosal invasion, and endoscopic submucosal dissection (ESD) for relatively larger lesions involving the superficial submucosal layer. Both of these approaches have limitations, EMR cannot reliably ensure complete resection for larger tumors and recurrence is a key limitation. ESD reliably provides complete resection and an accurate pathological diagnosis but is associated with risk such as perforation or bleeding. In addition, both EMR and ESD may be ineffective in treating subepithelial lesions that extend beyond the submucosa. Endoscopic full-thickness resection (EFTR) is an emerging innovative endoscopic therapy which was developed to overcome the limitations of EMR and ESD. Advantages include enabling a transmural resection, complete resection of complex colorectal lesions involving the mucosa to the muscularis propria. Recent studies comparing EFTR with current resection techniques and radical surgery for relatively complicated and larger lesion have provided promising results. If the current trajectory of research and development is maintained, EFTR will likely to become a strong contender as an alternative standard of care for advanced colonic lesions. In the current study we aimed to address this need, and highlighted the areas of future research, while stressing the need for multinational collaboration provide the steppingstone(s) needed to bring EFTR to the mainstream.
大多数结肠病变的大小小于10毫米，经过适当基础培训的内镜医师很容易将其切除。大小≥10毫米的病变在技术上难以切除，且不完全切除率较高。目前，主要的内镜治疗方法包括对无黏膜下浸润的病变进行内镜黏膜切除术（EMR），以及对累及浅黏膜下层的相对较大病变进行内镜黏膜下剥离术（ESD）。这两种方法都有局限性，EMR不能可靠地确保较大肿瘤的完全切除，复发是一个关键限制。ESD能可靠地实现完全切除并提供准确的病理诊断，但存在穿孔或出血等风险。此外，EMR和ESD在治疗超出黏膜下层的上皮下病变时可能均无效。内镜全层切除术（EFTR）是一种新兴的创新性内镜治疗方法，其开发目的是克服EMR和ESD的局限性。优点包括能够进行透壁切除，完整切除累及从黏膜到固有肌层的复杂结直肠病变。最近比较EFTR与当前切除技术以及针对相对复杂和较大病变的根治性手术的研究已取得了有前景的结果。如果保持当前的研发轨迹，EFTR很可能成为晚期结肠病变替代标准治疗方法的有力竞争者。在本研究中，我们旨在满足这一需求，并突出了未来研究领域，同时强调了跨国合作的必要性，以为将EFTR引入主流治疗提供必要的垫脚石。
