内镜下黏膜切除术与内镜黏膜下剥离术成功根除巴雷特食管肿瘤后复发情况的回顾性比较

Recurrence following successful eradication of neoplasia with endoscopic mucosal resection compared with endoscopic submucosal dissection in Barrett's esophagus: a retrospective comparison.

作者信息

Fujiyoshi Yusuke, Khalaf Kareem, Tham Daniel, Fujiyoshi Mary Raina Angeli, Calo Natalia C, Mosko Jeffrey D, May Gary R, Teshima Christopher W

机构信息

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada.

Department of Medicine, Division of Gastroenterology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada.

出版信息

Endoscopy. 2025 Jan;57(1):5-13. doi: 10.1055/a-2382-5891. Epub 2024 Sep 3.

DOI:10.1055/a-2382-5891

PMID:39227019

Abstract

BACKGROUND

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective treatments for Barrett's neoplasia. However, little is known about recurrence rates following these techniques. We compared long-term neoplasia recurrence rates following EMR and ESD.

METHODS

This study included patients with Barrett's neoplasia (high grade dysplasia/adenocarcinoma) treated between July 2019 and December 2023 at a tertiary referral center in Canada. Outcomes were residual neoplasia at first follow-up, complete remission of neoplasia (CRN), and neoplasia recurrence following CRN.

RESULTS

157 patients were included (87 EMR, 70 ESD). Compared with EMR, the ESD group had larger lesions (median 2 vs. 3 cm, <0.05), more adenocarcinoma (85.1% vs. 94.3%, = 0.07), and deeper submucosal invasion (T1a: 71.6% vs. 75.8%; T1b-SM1: 25.7% vs. 6.1%; T1b≥SM2: 2.7% vs. 18.2%; <0.05). Among 124 patients with follow-up (71 EMR, 53 ESD), 84.9% of ESD-treated patients had curative resections (i.e. R0 resection with low risk for lymph node metastasis), whereas 94.4% of EMR-treated patients had deep margin R0 resection of low risk lesions. At first follow-up, residual neoplasia (14.1% vs. 11.3%) and CRN (97.2% vs. 100%) were similar in the EMR and ESD groups, but neoplasia recurrence following CRN was significantly higher with EMR (13% vs. 1.9%, <0.05), with cumulative probability of recurrence at 3 years of 18.3% vs. 4.2%, respectively.

CONCLUSIONS

Neoplasia recurrence following CRN was significantly higher following EMR compared with ESD, suggesting that ESD may be superior to EMR in preventing neoplasia recurrence in Barrett's esophagus.

摘要

背景

内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）是治疗巴雷特肿瘤的有效方法。然而，对于这些技术后的复发率知之甚少。我们比较了EMR和ESD术后的长期肿瘤复发率。

方法

本研究纳入了2019年7月至2023年12月在加拿大一家三级转诊中心接受治疗的巴雷特肿瘤（高级别异型增生/腺癌）患者。观察指标为首次随访时的残留肿瘤、肿瘤完全缓解（CRN）以及CRN后的肿瘤复发。

结果

共纳入157例患者（87例行EMR，70例行ESD）。与EMR相比，ESD组病变更大（中位数2 cm对3 cm，<0.05），腺癌更多（85.1%对94.3%，P = 0.07），黏膜下浸润更深（T1a：71.6%对75.8%；T1b-SM1：25.7%对6.1%；T1b≥SM2：2.7%对18.2%；<0.05）。在124例接受随访的患者中（71例行EMR，53例行ESD），84.9%接受ESD治疗的患者实现了根治性切除（即R0切除且淋巴结转移风险低），而94.4%接受EMR治疗的患者对低风险病变进行了深切缘R0切除。首次随访时，EMR组和ESD组的残留肿瘤（14.1%对11.3%）和CRN（97.2%对100%）相似，但EMR术后CRN后的肿瘤复发明显更高（13%对1.9%，<0.05），3年累计复发概率分别为18.3%和4.2%。