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首页> 外文期刊>Surgical Endoscopy >Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma.
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Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma.

机译：内窥镜黏膜切除术使用带盖的内窥镜和内镜黏膜下剥离术作为浅表食管癌的最佳内窥镜检查程序。

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BACKGROUND: Endoscopic mucosal resection using a cap-fitted panendoscope (EMRC) and an endoscopic submucosal dissection (ESD) are increasingly performed to treat superficial esophageal carcinoma (SEC). As an endoscopic procedure appropriate for en bloc complete resection, ESD requires a much higher level of skill and experience than EMRC. METHODS: This retrospective study reviewed 127 SECs in 112 patients treated by EMRC or ESD from January 1997 to September 2009. RESULTS: For lesions 10 mm in diameter or smaller, EMRC and ESD had equivalent en bloc resection rates with tumor-free margins (en bloc + R0 resection rates). For lesions 11 mm in diameter or larger, however, the rate was significantly higher in the ESD group than in the EMRC group (p < 0.01). The mean procedure time was significantly longer in the ESD group than in the EMRC group (p < 0.01) regardless of lesion size. No significant difference was found in esophageal perforation rate between the EMRC and ESD groups. Severe esophageal stricture developed after EMRC of eight lesions (14.3%) and after ESD of six lesions (8.5%). For patients with a mucosal defect involving more than three-fourths of the esophageal circumference, the incidence of severe esophageal stricture after procedure was significantly higher in the EMRC group than in the ESD group (p < 0.05). The overall local recurrence rate was 3.1% (4/127) during an average follow-up period of 39 months (range, 8-123 months). All local recurrences were detected as superficial cancers after EMRC and then treated endoscopically. CONCLUSIONS: For lesions 10 mm in diameter or smaller, EMRC was found to be optimal. For lesions 11 mm in diameter or larger, however, ESD was superior to EMRC in efficacy as assessed by the en bloc + R0 resection rate. Furthermore, ESD was advantageous in preventing stricture formation. The operating endoscopist should carefully select EMRC or ESD according to lesion size.
机译：背景：越来越多地进行了使用帽盖式内窥镜（EMRC）的内镜黏膜切除术和内镜黏膜下剥离术（ESD）来治疗浅表食管癌（SEC）。作为适用于整体切除的内窥镜检查程序，与EMRC相比，ESD需要更高水平的技能和经验。方法：这项回顾性研究回顾了1997年1月至2009年9月接受EMRC或ESD治疗的112例患者的127 SEC。结果：对于直径10 mm或更小的病变，EMRC和ESD的整体切除率无肿瘤边界（en组+ R0切除率）。但是，对于直径为11 mm或更大的病变，ESD组的患病率明显高于EMRC组（p <0.01）。不管病变大小如何，ESD组的平均手术时间明显长于EMRC组（p <0.01）。 EMRC组和ESD组之间的食管穿孔率没有显着差异。 EMRC治疗后有八个病变（14.3％）和ESD治疗后有六个病变（8.5％），出现严重的食管狭窄。对于黏膜缺损占食管周长的四分之三以上的患者，EMRC组手术后严重食管狭窄的发生率明显高于ESD组（p <0.05）。在平均39个月（8至123个月）的平均随访期间，总体局部复发率为3.1％（4/127）。 EMRC后所有局部复发均被发现为浅表癌，然后进行内镜治疗。结论：对于直径10mm或更小的病变，发现EMRC是最佳的。但是，对于直径大于等于11毫米的病变，通过整体+ R0切除率评估，ESD的疗效优于EMRC。此外，ESD在防止狭窄形成方面是有利的。手术中的内镜医师应根据病变大小仔细选择EMRC或ESD。

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