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首页> 外文期刊>Gastrointestinal Endoscopy >Endoscopic submucosal dissection for treatment of rectal carcinoid tumors.
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Endoscopic submucosal dissection for treatment of rectal carcinoid tumors.

机译：内镜黏膜下剥离术治疗直肠类癌。

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BACKGROUND: Conventional EMR has been the endoscopic treatment of choice for rectal carcinoid tumors. However, histologically complete resection often cannot be achieved because the carcinoid tumors are located mainly in the submucosal layer. Endoscopic submucosal dissection (ESD), a new method for large colorectal neoplasm resection, may overcome this problem. OBJECTIVE: To compare ESD with EMR for the endoscopic treatment of rectal carcinoid tumors. DESIGN: A prospective case series with comparison to retrospective controls. SETTING: Tertiary-care center. PATIENTS: From January 2007 to January 2009 we prospectively enrolled consecutive patients with rectal carcinoid tumors less than 16 mm in diameter and with no regional lymph node enlargement shown by CT or EUS. For comparison, we retrospectively randomly selected patients who had undergone EMR for treatment of rectal carcinoid tumors between March 2000 and December 2006. INTERVENTION: We performed ESD of rectal carcinoid tumors in prospectively enrolled patients. MAIN OUTCOME MEASUREMENTS: Rate of en bloc resection, rate of histologically complete resection, incidence of complications, and length of procedures. RESULTS: The ESD group contained 31 patients (18 male, 13 female; age range 34-65 years), and the EMR group contained 62 patients (42 male, 20 female; age range 22-77 years). Both groups had similar mean rectal carcinoid tumor diameters (ESD 6.8 +/- 2.4 mm, EMR 7.3 +/- 2.2 mm; P = .106). Resection time was longer in the ESD group than in the EMR group (11.4 +/- 3.7 minutes vs 4.2 +/- 3.2 minutes, P < .001). The en bloc resection rate was 100% (31 of 31) in the ESD group and 95.2% (59 of 62) in the EMR group (P = .213). The histologically complete resection rate was 90.3% (28 of 31) in the ESD group and 71.0% (44 of 62) in the EMR group (P = .035). Suspected perforation occurred in 1 ESD patient (3.2%) and in 1 EMR patient (1.6%), and both patients were successfully managed by conservative measures. Immediate bleeding occurred in 1 ESD patient (3.2%) and in 4 EMR patients (6.5%); all instances of bleeding were controlled endoscopically. LIMITATIONS: Retrospective control study and limited experience at a single center. CONCLUSION: Compared with EMR, ESD resulted in a higher histologically complete resection rate, had a similar complication rate, and took slightly longer to perform. Given the advantages of complete resection, these findings indicate that ESD may be considered for treatment of rectal carcinoid tumors.
机译：背景：常规EMR已成为直肠类癌肿瘤的内镜治疗选择。然而，由于类癌肿瘤主要位于粘膜下层，因此通常无法实现组织学上的完全切除。内镜下黏膜下剥离术（ESD），一种用于大肠直肠肿瘤切除术的新方法，可以克服这个问题。目的：比较ESD和EMR在内镜治疗直肠类癌中的作用。设计：与回顾性对照比较的前瞻性病例系列。地点：三级护理中心。患者：自2007年1月至2009年1月，我们连续入选了直肠类癌肿瘤直径小于16毫米且CT或EUS未显示区域淋巴结肿大的连续患者。为了进行比较，我们回顾性选择了2000年3月至2006年12月间接受过EMR治疗的直肠类癌肿瘤的患者。干预：我们对预期纳入的患者进行了直肠类癌的ESD。主要观察指标：整体切除率，组织学完整切除率，并发症发生率和手术时间。结果：ESD组包含31例患者（男18例，女性13例;年龄范围34-65岁），EMR组包含62例患者（42例男性，20例女性;年龄范围22-77岁）。两组平均直肠类癌肿瘤直径相似（ESD 6.8 +/- 2.4 mm，EMR 7.3 +/- 2.2 mm; P = .106）。 ESD组的切除时间比EMR组更长（11.4 +/- 3.7分钟vs 4.2 +/- 3.2分钟，P <.001）。 ESD组的整体切除率为100％（31个中的31个），EMR组的整体切除率为95.2％（62个中的59个）（P = .213）。 ESD组的组织学完整切除率为90.3％（31中的28），EMR组为71.0％（62中的44）（P = .035）。疑似穿孔发生在1名ESD患者（3.2％）和1名EMR患者（1.6％）中，并且两名患者均通过保守措施成功治疗。 1名ESD患者（3.2％）和4名EMR患者（6.5％）立即出血。所有出血实例均通过内镜控制。局限性：回顾性对照研究和单一中心的经验有限。结论：与EMR相比，ESD在组织学上具有更高的完全切除率，并发症发生率相似，并且执行时间略长。鉴于完全切除的优势，这些发现表明，ESD可考虑治疗直肠类癌。

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