内镜黏膜下剥离术与内镜黏膜切除术治疗早期食管腺癌。

Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma.

机构信息

Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.

Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France.

出版信息

Clin Res Hepatol Gastroenterol. 2023 May;47(6):102138. doi: 10.1016/j.clinre.2023.102138. Epub 2023 May 9.

DOI:10.1016/j.clinre.2023.102138

PMID:37169124

Abstract

OBJECTIVES

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopic resection of early esophageal adenocarcinoma. The choice between the two techniques takes into account the morphology of the lesion, and the experience of the endoscopist. The aim of this study was to compare EMR to ESD for the treatment of early esophageal adenocarcinoma.

METHODS

Patients who underwent an endoscopic resection for esophageal adenocarcinomas between March 2015 and December 2019 were included. ESD was compared to EMR in terms of clinical, procedural, histologic, and oncologic outcomes.

RESULTS

85 patients were included: 57 ESD and 28 EMR. The median (IQR) diameter of the lesion was 20(15-25) mm in the ESD group, and 15(8-16) mm in the EMR group, p<0.01. ESD allowed en bloc resection in 100% of cases, and EMR in 39% of cases, p<0.001. The R0 and curative resection rate in the ESD group versus the EMR group were 88% and 67%, respectively, versus 21% and 11%, p<0.001. We recorded one severe adverse event, in the EMR group. After a median (IQR) follow-up of 27.5 (14.5-38.7) months, the local recurrence rate was 23% vs. 18% (p = 0.63), and the overall survival 89% vs. 86% (p = 0.72), in the ESD and EMR groups, respectively.

CONCLUSION

ESD was as safe as EMR and allowed higher en bloc, R0 and curative resection rates. Although these results did not translate into long-term outcomes, these data prompt for a broader adoption of ESD for the resection of esophageal lesions suspected of harboring early esophageal adenocarcinoma.

摘要

目的

内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）可用于早期食管腺癌的内镜切除。两种技术的选择取决于病变的形态和内镜医生的经验。本研究旨在比较 EMR 和 ESD 治疗早期食管腺癌的效果。

方法

纳入 2015 年 3 月至 2019 年 12 月期间接受内镜切除术治疗的食管腺癌患者。比较 ESD 和 EMR 在临床、手术、组织学和肿瘤学结局方面的差异。

结果

共纳入 85 例患者：57 例 ESD 和 28 例 EMR。ESD 组病变的中位（IQR）直径为 20（15-25）mm，EMR 组为 15（8-16）mm，p<0.01。ESD 组 100%的病例可整块切除，而 EMR 组仅 39%的病例可整块切除，p<0.001。ESD 组和 EMR 组的 R0 切除率和根治性切除率分别为 88%和 67%，21%和 11%，p<0.001。ESD 组仅记录到 1 例严重不良事件。中位（IQR）随访 27.5（14.5-38.7）个月后，ESD 组和 EMR 组的局部复发率分别为 23%和 18%（p=0.63），总生存率分别为 89%和 86%（p=0.72）。