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首页> 外文期刊>Endoscopy International Open >Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience
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Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience

机译：直肠肿瘤内窥镜粘膜粘膜粘膜清除的安全性和有效性：多中心北美经验

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Background and aims?Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America. Methods?This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection. Results?In total, 171 patients (median age 63 years; 56?% men) underwent rectal ESD (median size 43?mm). En bloc resection was achieved in 141 cases (82.5?%; 95?%CI 76.8–88.2), including 24 of 27 (88.9?%) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9?% (95?%CI 68.4–81.4). Post-ESD bleeding and perforation occurred in 4 (2.3?%) and 7 (4.1?%), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6?% of post-ESD specimens. There was one case (1/120; 0.8?%) of recurrence at a median follow-up of 31 weeks; IQR: 19–76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection. Conclusion?Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.
机译：背景和目标？直肠病变传统上代表了在西方内窥镜粘膜颌面颌面颌面颌面释放（ESD）培训期间接近的第一个病变。我们评估了直肠ESD在北美的安全性和有效性。方法？这是2010年1月至2018年9月在15个中心之间对直肠ESD的多中心回顾性分析。终点包括：EN集团切除率，R0切除术，不良事件，预先和ESD后组织学的比较，以及与切除术失败相关的因素。结果？总共171名患者（63岁; 56？％男性）接受直肠ESD（中位数43？mm）。在141例（82.5μl％; 95〜5℃）的情况下实现了Zhoc切除术，其中包括预先发生的内窥镜粘膜切除（EMR）的27例（88.9倍）的24例。 R0切除率为74.9？％（95〜％CI 68.4-81.4）。 ESD后出血和穿孔分别发生在4（2.3Ω％）和7（4.1μl）中发生。封闭粘膜肠癌（SMIC）在8.6℃的ESD后标本中鉴定出来。在31周的中位随访中，有一种案例（1/120; 0.8？％）复发; IQR：19-76周）。年龄较大的身体和更高的身体质量指数（BMI）是R0切除术失败的预测因子，而粘膜纤维化与ZHOC和R0切除术失败的较高可能性有关。结论？北美的直肠ESD是安全的，与高EN BLOC和R0切除率有关。粘膜纤维化的存在是失败的en Bloc和R0切除的主要预测因子。 ESD可以考虑选择直肠病变，不仅可以建立确定的组织诊断，还可以为具有隐蔽晚期疾病的病变提供治疗切除。

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