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首页> 外文期刊>Endoscopy International Open >Implementation of endoscopic submucosal dissection for early upper gastrointestinal tract cancer after primary experience in colorectal endoscopic submucosal dissection
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Implementation of endoscopic submucosal dissection for early upper gastrointestinal tract cancer after primary experience in colorectal endoscopic submucosal dissection

机译：内镜下黏膜下剥离术对大肠内镜下黏膜下剥离的初步经验后早期上消化道癌的实施

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Background Current guidelines recommend endoscopic submucosal dissection (ESD) as a treatment option for early cancers of the upper gastrointestinal tract with absent or minimal risk of lymph node metastasis. However, due to the low prevalence of these entities, it is difficult to achieve a competence level for ESD of upper gastrointestinal tract cancers in the Western World. Here, we present single-center data on the implementation of upper gastrointestinal ESD after previous experience with 89 colorectal ESD cases. Methods Retrospective case series of 39 consecutive patients with early cancers of the esophagus (n?=?13) or cardia and stomach (n?=?26) treated with ESD over a 4-year period. Results ESD was technically feasible in all cases with en bloc, R0, and curative resection rates of 100?%, 76.9?%, and 71.8?%, respectively, and a mean procedure time of 100 minutes (30?–?360 minutes). After an initial 20 procedures, the R0 and curative resection rates increased from 65.0?% to 89.5?%, and from 60.0?% to 84.2?%, respectively. Complications were observed in four patients (10.3?%): three perforations, one case of delayed bleeding, and one esophageal stricture. No case required emergency surgery; the 30-day mortality rate was 0?%. Conclusion In this modest case series from Europe, we observed an effectiveness and complication rate for ESD for early esophageal and gastric cancer that are comparable to other series from Europe but also to more abundant data from Asia. The results indicate that even small numbers of upper gastrointestinal cancers can be managed adequately in centers with expertise in colorectal ESD.
机译：背景技术当前的指南建议内镜下黏膜下剥离术（ESD）作为上消化道早期癌症的淋巴结转移风险不高或风险最小的治疗选择。但是，由于这些实体的患病率低，因此在西方世界中很难达到上消化道癌的ESD能力。在此，我们根据89例大肠ESD病例的先前经验，介绍了上消化道ESD实施的单中心数据。方法回顾性系列病例，连续4年，接受ESD治疗的39例早期食道癌（n = 13）或card门和胃癌（n = 26）患者。结果在所有情况下，整块，R0和根治性切除率分别为100％，76.9％和71.8％的ESD在技术上都是可行的，平均手术时间为100分钟（30-–360分钟） 。经过最初的20个步骤，R0和根治性切除率分别从65.0％增加到89.5％，从60.0％增加到84.2％。在4例患者（10.3％）中观察到并发症：3例穿孔，1例延迟出血和1例食管狭窄。没有病例需要紧急手术; 30天死亡率为0％。结论在这个来自欧洲的温和病例系列中，我们观察到了ESD对早期食道和胃癌的有效性和并发症发生率，与欧洲的其他系列可比，而且与亚洲的更丰富的数据相当。结果表明，即使只有少数上消化道癌，在具有大肠ESD专门知识的中心也可以得到适当管理。

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