Curative treatment for high-grade intraepithelial neoplasia in Barrett's esophagus

BACKGROUND AND STUDY AIMS: The incidence of premalignant and malignant lesions in specialized intestinal metaplasia of the esophagus has increased dramatically in the industrialized world in recent years. This report evaluates the efficacy and safety of local endoscopic therapy for high-grade intraepithelial neoplasia (HGIN) in Barrett's esophagus. PATIENTS AND METHODS: Over a 5-year period between October 1996 and September 2001, a total of 379 patients were referred with a suspicion of early Barrett's cancer. In a prospective study, 44 patients with HGIN in Barrett's esophagus were selected for local endoscopic treatment. Endoscopic resection was carried out in 14 patients in whom the HGIN was re-detectable, and 27 patients in whom the HGIN was not re-detectable underwent photodynamic therapy (PDT). Endoscopic resection and PDT were combined in three patients. RESULTS: Complete remission was achieved in 43 of the 44 patients (97.7 %). No major complications occurred. A mean of 1 session was needed to achieve complete local remission. During a mean follow-up period of 36 months (range 7 - 61 months), recurrent or metachronous lesions were observed in six patients (17.1 %), all of whom received a second successful endoscopic treatment. CONCLUSIONS: Endoscopic therapy is a safe alternative treatment regimen for HGIN in Barrett's esophagus, providing a middle way between the widely promulgated options of a "watch-and-wait" policy and radical esophagectomy.     

内镜黏膜下剥离术治疗老年早期上消化道肿瘤的效果

目的 探讨内镜黏膜下剥离术治疗老年上消化道早期肿瘤的疗效.方法 收集安徽医科大学附属安庆医院消化内科2017年3月至2019年10月收治的67例老年上消化道早期肿瘤患者的临床资料,患者入院后均行内镜黏膜下剥离术(ESD),术后跟踪随访,评估内镜治疗的术前术后病理结果、并发症发生率、病灶整块切除率、住院时间、术后残留及复...     

Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients

BACKGROUND AND STUDY AIMS: Treatment by endoscopic mucosal resection (EMR) has been established for early lesions in Barrett's esophagus. However, the remaining Barrett's esophagus epithelium remains at risk of developing further lesions. The aim of this study was to evaluate the efficacy of circumferential endoscopic mucosectomy (circumferential EMR)s in removing not only the index lesion (high-grade intraepithelial neoplasia (HGIN) or mucosal cancer), but also the remaining Barrett's esophagus epithelium. PATIENTS AND METHODS: A total of 21 patients were included in the study (11 men, 10 women), who had Barrett's esophagus and either HGIN (n = 12) or mucosal cancer (n = 9). Of the patients, 17/21 were at high surgical risk and five had refused surgery. On the basis of preprocedure endosonography their lesions were classified as T1N0 (n = 19) or T0N0 (n = 2). The lesions and the Barrett's esophagus epithelium were removed by polypectomy after submucosal injection of 10-15 ml of saline; a double-channel endoscope was used in 15/21 cases. Circumferential EMR was performed in two sessions, the lesion and the surrounding half of the circumferential Barrett's esophagus mucosa being removed in the first session. In order to prevent the formation of esophageal stenosis, the second half of the Barrett's esophagus mucosa was resected 1 month later. RESULTS: Complications occurred in 4/21 patients (19 %), consisting of bleeding which was successfully managed by endoscopic hemostasis in all cases. No strictures were observed during follow-up (mean duration 18 months) and endoscopic resection was considered complete in 18/21 patients (86 %). For three patients, histological examination showed incomplete removal of tumor: one of these underwent surgery; two received chemoradiotherapy, and showed no evidence of residual tumor at 18 months' and 24 months' follow-up, respectively. Two patients in whom resection was initially classified as complete later presented with local recurrence and were treated again by EMR. Barrett's esophagus mucosa was completely replaced by squamous cell epithelium in 15/20 patients (75 %). CONCLUSIONS: Circumferential EMR is a noninvasive treatment of Barrett's esophagus with HGIN or mucosal cancer, with a low complication rate and good short-term clinical efficacy. Further studies should focus on long-term results and on technical improvements.     

窄带成像技术对胃黏膜高级别上皮内瘤变患者临床疗效的影响

目的探究窄带成像技术(NBI)对胃黏膜高级别上皮内瘤变(HGIN)患者临床疗效的影响。方法选取2006年6月-2016年6月该院接收治疗的96例胃黏膜HGIN患者为研究对象,采用随机数表法将患者分为对照组和观察组,各48例。对照组患者采用内镜黏膜下剥离术(ESD)治疗,观察组患者采用NBI联合ESD治疗。比较两组患者的各项手术情况、术后病理分型和并发症发生情况。结果观察组患者的手术时间、切缘阳性率均低于对照组,病灶直径、一次性整块切除率和治愈性切除率均高于对照组,差异具有统计学意义(P0.05)。观察组术后病理分型包括27例HGIN癌变患者,15例HGIN伴局灶癌变患者和6例高-中分化腺癌患者,对照组术后病理分型包括1例低级别上皮内瘤变(LGIN)患者,33例HGIN癌变患者,11例HGIN伴局灶癌变患者和3例高-中分化腺癌患者,差异无统计学意义(P0.05)。观察组与对照组患者的并发症总发生率分别为6.25%和22.92%,观察组明显低于对照组,差异具有统计学意义(P0.05)。结论采用NBI联合内镜治疗胃黏膜HGIN患者能够显著提高病灶的整块完整切除率和治愈性切除率,缩短手术时间,降低并发症发生率。     

Histological analysis of endoscopic resection specimens from 326 patients with Barrett's esophagus and early neoplasia

BACKGROUND AND STUDY AIMS: Endoscopic resection has been recommended as a local curative approach for Barrett's neoplasia, but large series are still rare. In the present study we analyzed the histological characteristics of endoscopic resection specimens of Barrett's neoplasia. PATIENTS AND METHODS: 742 endoscopic resection specimens obtained from 326 patients were assessed. The following histological characteristics were evaluated: type of neoplasia, grade of differentiation, depth of infiltration, invasion into lymphatic and blood vessels, and resection status (tumor-free margins were regarded as indicating R0 status). RESULTS: 31 patients had no neoplasia and were excluded from the analysis. Among the remaining 295 patients (711 resection specimens), histological findings were: low-grade intraepithelial neoplasia, 1.0 %; high-grade intraepithelial neoplasia, 2.7 %; and mucosal carcinoma 80.3 %. Carcinomas infiltrating the submucosal layer were rare (sm1 7.5 %; sm2 3.7 %; sm3 4.8 %), as were those invading lymph vessels (3.5 %), and there were none with venous invasion. Most of the carcinomas were well-differentiated (72.2 %), and many of these (92.7 %) were limited to the mucosa, in contrast to moderately and poorly differentiated carcinomas (73.7 % and 22.7 %, respectively). R0 status was achieved in 74.5 % of patients; in 47.8 % this was after repeated endoscopic resection. In 26.8 % of patients, R0 resection was achieved at the first attempt. CONCLUSIONS: Our study demonstrates that early Barrett's neoplasms removed by endoscopic resection are mostly limited to the mucosa, are well to moderately differentiated, and very rarely show invasion of the lymph or blood vessels. Although these lesions seem to be low risk with regard to metastatic spread and therefore treatable endoscopically, improved endoscopic resection methods for achieving one-piece (en bloc) R0 resection should be developed.     

Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques

BACKGROUND AND STUDY AIMS: In recent years, short-segment Barrett's esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation. PATIENTS AND METHODS: Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett's adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments. RESULTS: Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 +/- 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 +/- 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett's adenocarcinoma (this was the patient who underwent esophageal resection). CONCLUSIONS: The malignant potential of short-segment Barrett's esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett's esophagus.     

胃镜精检在首次胃镜提示胃癌前病变中的应用价值*

目的探讨联合应用放大内镜、染色内镜、窄带成像(NBI)及高频超声微探头对首次胃镜提示胃癌前病变的患者进行再次胃镜精检的价值。方法 2014年6月-2015年7月,对该科首次胃镜病理发现胃低级别上皮内瘤变(LGIN)、高级别上皮内瘤变(HGIN)的患者进行电话召回,应用放大内镜、染色内镜和NBI等进行胃镜精检,发现有可疑病灶时进行高频超声微探头检查以判断浸润深度。萎缩性胃炎及肠化但未合并上皮内瘤变的患者未纳入本研究。共65例符合上述标准的患者入选,初次胃镜提示LGIN 56例、HGIN 9例。结果 65例患者最终证实胃癌14例,首诊为LGIN 7例,HGIN 7例。14例胃癌患者中9例于该院治疗[5例行内镜黏膜下剥离术(ESD)、4例手术],其中早期胃癌8例(6例黏膜内癌、2例浸润黏膜下层),1例进展期癌(浸润至浅肌层),另5例均呈早癌内镜表现,但因拒绝于该院治疗,无法确诊分期。结论胃镜检查发现上皮内瘤变时,往往提示存在早期癌变的可能,对该类患者进行有针对性的胃镜精检有助于发现之前遗漏的早癌病灶,避免漏诊。     

Frequency of Barrett's neoplasia after initial negative endoscopy with biopsy: a long-term histopathological follow-up study

BACKGROUND: Barrett's adenocarcinoma is being diagnosed increasingly. We examine possible differences between long segment and short-segment Barrett esophagus (LSBE and SSBE) in long-term follow-up on the basis of our histopathology registry. METHODS AND PATIENTS: All Barrett's esophagus patients diagnosed histologically between 1990 and 1995 (n = 1071) were selected. Long-term follow-up data from endoscopy with biopsy were sought on all patients without neoplasia on initial endoscopic biopsy (n = 1003). A total of 255 individuals (25.4 %) were regarded as drop-outs (201 lost and 54 without further endoscopy). Of the remaining 748 patients with follow up for more than 5 years, 315 had documented LSBE, 246 had SSBE, and 187 had no length of Barrett esophagus recorded (NLBE). RESULTS: In the study cases (male : female ratio 2.1 : 1, mean age +/- SD 60.9 +/- 14.2 years), the biopsy procedure was fully compliant with guidelines in only 32.5 %. Only 5 cases (0.6 %) had visible lesions reported on endoscopy, but all were negative for neoplasia. Over a mean follow-up of 78.2 +/- 35.6 months (range 0-240), 7 new cases of low grade intraepithelial neoplasia (LGIN) and 15 cancer cases developed, accounting for a yearly incidence of 0.2 % (LGIN) or 0.4 % (cancer) after an initial negative endoscopy. When the cases with initial diagnosis of neoplasia were included, this yearly incidence rose to 0.5 % (LGIN), 0.3 % (high grade intraepithelial neoplasia [HGIN]) or 1.7 % (cancer). Differences between SSBE and LSBE were only encountered for cancer incidence. CONCLUSION: The yearly incidence of Barrett esophagus cancer varies between 0.4 % and 1.7 %. Despite the limitations of this retrospective and pathology-based study, the observed risk of developing cancer in Barrett esophagus without neoplasia is comparable to that found in other studies, mainly from the US and the UK, and varies between 0.7 % and 1.0 % of yearly incidence.     

Endoscopic fluorescence detection of intraepithelial neoplasia in Barrett's esophagus after oral administration of aminolevulinic acid

BACKGROUND AND STUDY AIMS: Barrett's esophagus is strongly associated with adenocarcinoma. Early malignant transformation of the Barrett's mucosa is often not visible endoscopically and may remain undetected until the invasive adenocarcinoma stage. Endoscopic surveillance is currently carried out on random four-quadrant biopsies at 1-2 cm intervals. Endoscopic fluorescence detection of protoporphyrin IX induced by 5-aminolevulinic acid can identify premalignant lesions. This study evaluates endoscopic fluorescence detection in patients having Barrett's esophagus and compares the results to those of standard endoscopy with random four-quadrant biopsies. PATIENTS AND METHODS: The study included 30 examinations in 28 patients (22 men, 6 women; age range 37-78 years, mean age 60 years,), with five patients having known intraepithelial neoplasia. A dose of 20 mg/kg of 5-aminolevulinic acid was given orally 5 hours before examination. Random four-quadrant biopsies were performed 4-6 weeks before endoscopic fluorescence detection. RESULTS: Of the biopsies taken during the endoscopic fluorescence detection procedure, 28 % (23/81) were true positives. More than one-third of the false-positive results were due to inflammation. None of the 97 control biopsies taken on nonfluorescing areas during endoscopic fluorescence detection were dysplastic. Endoscopic fluorescence detection showed low-grade intraepithelial neoplasia in five patients which was not diagnosed with random four-quadrant biopsies, while random four-quadrant biopsies alone showed three low-grade intraepithelial neoplasias that were invisible during endoscopic fluorescence detection. All high-grade intraepithelial neoplasias or adenocarcinomas (2/2) were detected with both methods. CONCLUSIONS: Fluorescence detection achieved a similar performance when compared with four-quadrant random biopsy, but resulted in fewer biopsies (81 for endoscopic fluorescence detection vs 531 for random four-quadrant biopsies).     

Endoscopic resection of submucosal esophageal tumors: a prospective case series

BACKGROUND AND STUDY AIM: The introduction of endoscopic ultrasound (EUS) and endoscopic mucosal resection has offered a new alternative to simple observation or surgical resection for the management of esophageal submucosal tumors. PATIENTS AND METHODS: During a 4-year period, endoscopic resection was attempted in 20 consecutive patients (nine women, 11 men; mean age 52 +/- 10 years) with esophageal submucosal tumors < 4 cm in size, confirmed by endoscopy and miniprobe EUS (20 MHz). The mean tumor diameter was 17 +/- 8 mm (8 - 34 mm). Prior EUS-guided cytological examination revealed benign tumors in 11 patients; however, endoscopic resection was attempted in most patients for diagnostic purposes also. Several patients were symptomatic (retrosternal pain, n = 4; dysphagia, n = 4; recurrent bleeding, n = 2) but most tumors had been detected incidentally. RESULTS: In the majority of patients the tumor was ligated with a rubber band and then resected with a snare (n = 11), and in the others simple snare resection ("lift-and-cut," n = 7) or cap resection (n = 2) was done. A macroscopically complete endoscopic resection was achieved in 19/20 patients, and the remaining patient was managed surgically. Endoscopic hemostasis was necessary (and successful) in eight patients (40 %), but blood transfusion was not required. No other side effects occurred. Histological examination revealed granular cell tumor in 12 patients, leiomyoma in six patients, and a lipoma and stromal tumor in one patient each. Histologically, all tumors were judged to be benign and a microscopically complete resection (R0) was achieved in all patients, with the exception of the one patient with a stromal tumor. Thus, surgical resection was necessary in only two of the 20 patients (10 %). During the median prospective follow-up of 12 months no tumor recurrence was detected in any patient. CONCLUSION: Endoscopic resection of esophageal submucosal tumors is safe and effective. The probability of achieving curative resection (R0 resection, histologically benign) is high especially if the tumors are smaller in size (< 4 cm).     

An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions 相似文献   

内镜下多环黏膜套扎切除术治疗食管癌前病变和食管早癌的疗效及安全性分析*

目的探讨内镜下多环黏膜套扎切除术(EMBM)治疗食管癌前病变和食管早癌的疗效及其安全性。方法回顾性分析2013年1月-2016年6月在该院内镜中心接受EMBM治疗的75例食管癌前病变和食管早癌患者,观察记录手术时间、手术并发症和治疗效果,对比术前和术后病理结果,并结合随访结果,分析总结EMBM的疗效。结果 75例患者均顺利完成EMBM术,手术时间(40.00±9.21)min,3例术中并发出血,均成功内镜下止血,无穿孔、迟发性出血和操作相关死亡发生。9例患者术后出现食管创面狭窄,予以内镜下球囊扩张后狭窄缓解。EMBM术后病理:低级别上皮内瘤变(LGIN)24处,高级别上皮内瘤变(HGIN)45处,黏膜内癌(IMCA)9处,所有患者水平切缘均阴性。相比较EMBM前的钳夹活检,有21处(26.9%)标本病理结果发生变化。随访期间,2例患者术后半年、4例患者术后1年复发,再次给予内镜成功治疗。其余患者随访期间未见复发。结论 EMBM具有操作简单、用时短和并发症少特点,是治疗食管早癌、尤其是食管癌前病变安全有效的方法。     

菱形结构域蛋白在胃癌中的表达

  目的  评价菱形结构域蛋白(rhomboid domain-containing protein 1, RHBDD1)在胃癌中的表达及其与胃癌发生、发展的关系。  方法  回顾性收集2015年1月至2018年1月北京医院消化内科收治的胃癌、癌前病变以及慢性浅表性胃炎患者的临床资料, 对病变的组织病理学诊断结果进行重新判读。根据病理诊断类型将入组患者的胃黏膜组织分为慢性浅表性胃炎(chronic superficial gastritis, CSG)、低级别上皮内瘤变(low-grade gastric intraepithelial neoplasia, LGIN)、高级别上皮内瘤变(high-grade gastric intraepithelial neoplasia, HGIN)、早期胃癌(early gastric cancer, EGC)和进展期胃癌(advanced gastric cancer, AGC)5组, 记录各组免疫组化检测RHBDD1在胃黏膜组织中的表达阳性率, 分析各组之间的差异。  结果  共76例152处病变入选本研究, 其中CSG 17处, LGIN 21处、HGIN 54处、EGC 44处、AGC 16处。CSG组织中RHBDD1的表达显著低于非CSG病变(LGIN、HGIN、EGC和AGC), 具有统计学差异(χ²=13.157, P=0.001)。病变胃黏膜RHBDD1表达的阳性率随病变严重程度逐渐升高[CSG(35.3%)→癌前病变(LGIN+HGIN)(74.7%)→EGC(75.0%)→AGC(87.5%)]。  结论  胃黏膜组织中RHBDD1的表达有可能为胃部疾病的良恶性鉴别提供有用线索。     

Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) is a widely accepted treatment for early gastric cancer; however, incomplete resection with residual local disease and recurrences continues to be a difficult problem. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for residual/local recurrent early gastric cancer lesions after EMR. PATIENTS AND METHODS: The en bloc resection rate, histologically complete resection rate, complications, and local recurrence were assessed in 15 patients who underwent ESD for residual/local recurrent early gastric cancer lesions after EMR. RESULTS: The nonlifting sign after injection of a glycerin solution was positive due to scar formation in all cases. En bloc resection was attempted in all cases, with a complete resection rate of 93.3 % (14 of 15). The lesion was completely resected with histologically adequate margins in the 14 patients who received complete en bloc resection. The average operation time was 85.4 +/- 52.9 min, and the mean follow-up period for all patients was 18.1 +/- 7.4 months. Major bleeding during the procedure in one case was the only complication (one of 15, 6.7 %). None of the patients experienced recurrence of early gastric cancer after ESD. CONCLUSIONS: ESD appears to be a safe and effective treatment for residual/local recurrent early gastric cancer lesions after EMR, and it is useful for histological confirmation of successful treatment.     

"Salvage" endoscopic mucosal resection in the colon using a retroflexion gastroscope dissection technique: a prospective analysis

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection and submucosal dissection can provide curative endoscopic therapy for Paris type I/II adenomas and node-negative early cancer. No studies have addressed the technical feasibility of retroflexion endoscopic dissection methods for luminal "salvage" therapy in patients considered unresectable using conventional forward-viewing resection. PATIENTS AND METHODS: Colonoscopy using an Olympus GIF-XQ240 gastroscope was carried out in 76 patients with Paris type I/II adenomas, early colorectal cancer (CRC), or laterally spreading tumors (LSTs) when the index endoscopist considered the lesion to be unresectable due to retrograde fold involvement. Endoscopic mucosal resection (EMR) and submucosal dissection were carried out using a complete retroflexion technique. Endoscopic and miniprobe 20-MHz or 12.5-MHz ultrasound follow-up data were collected prospectively up to 24 months after the index resection. RESULTS: Cecal intubation or cannulation to the neoterminal ileum was achieved in 76 (100 %) cases. Forty lesions (53 %) were classified in accordance with the Paris criteria as Is; 16 (21 %) as type II; 10 (13.5 %) as LST-G; and 10 (13.5 %) as LST-NG. Eight lesions (10 %) were excluded from EMR on the basis of endoscopic ultrasound criteria, with 68 of the 76 lesions (89 %) meeting the criteria for endoluminal resection. The median intubation time was 16 min (range 3-32 min). The median resection times were 98 min (range 30 - 242 min), 36 min (range 10-60 min), 172 min (range 20 - 240 min), and 60 min (range 10-116 min) for Paris Is, II, LST-G, and LST-NG lesions, respectively. LST-G morphology was associated with a high median submucosal injection volume in comparison with all other Paris types ( P < 0.05) and with a prolonged resection time ( P < 0.01). Sixty-one patients (94 %) completed the surveillance protocol. Higaki recurrence criteria were met in seven patients (11 %), with six undergoing successful adjunctive endoluminal resection. After 24 months of follow-up, the "cure" rate with endoscopic resection was 60 out of 61 (98 %). CONCLUSIONS: This is the first prospective study to address the safety and medium-term efficacy of retroflexion endoscopic resection in the colon. When appropriate exclusion criteria are applied, selected patients can receive curative resection using the retroflexion technique. "Salvage" endoluminal therapy may therefore be possible in such cases when surgical resection would otherwise have been required.     

Predictive value of magnification chromoendoscopy for diagnosing invasive neoplasia in nonpolypoid colorectal lesions and stratifying patients for endoscopic resection or surgery

BACKGROUND AND STUDY AIMS: In nonpolypoid colorectal lesions, the presence of irregular, distorted glands in the colon (a disrupted crypt pattern) on magnification chromoendoscopy (MCE) is strongly associated with submucosal invasive cancer. The aim of the present study was to evaluate the ability of MCE to differentiate between an invasive crypt pattern and a noninvasive crypt pattern, including nonneoplastic lesions, and to assess the ability of this MCE classification to predict invasiveness and allow patients to be selected for endoscopic resection or surgical resection. PATIENTS AND METHODS: In a prospective study including 1560 colonoscopies, 153 flat or depressed colorectal lesions were evaluated with MCE among 534 colorectal lesions; the remainder had a polypoid appearance. The pit pattern was classified as nonneoplastic (type II) or neoplastic (types III - V), and the latter was subdivided into noninvasive (types III or IV) or submucosally invasive (type V). Lesions with a nonneoplastic and noninvasive neoplastic appearance were resected endoscopically if technically feasible, whereas those with a type V pattern were resected surgically. The resection specimens were analyzed histologically in relation to the Vienna classification. RESULTS: Using this management strategy based on the pit pattern, 86 % (n = 70) of the type II lesions were hyperplastic; the remaining 11 had low-grade intraepithelial neoplasia. Type III and IV lesions (n = 58) represented either low-grade or high-grade intraepithelial neoplasia in 95 % of the cases. Three patients had sm1 (n = 2) or sm2/3 invasive cancers. Among the patients with type V lesions (n = 14), 11 had invasive cancers (four sm1 and seven sm2/3). Endoscopic differentiation based on the pit pattern thus had a positive predictive value (PPV) of 86 % and a negative predictive value of 96 % for distinguishing between nonneoplastic and neoplastic lesions. The pit pattern criteria for distinguishing between invasive and noninvasive neoplasia (including nonneoplastic lesions), and hence the choice between endoscopic and surgical resection, had a PPV of 79 % and a NPV of 98 %. Excluding nonneoplastic lesions, the NPV would be 95 %. CONCLUSIONS: The endoscopic pit pattern on MCE has only a moderate predictive value for nonneoplastic lesions, so that leaving these flat hyperplastic lesions in place on the basis of the endoscopic magnification appearance alone cannot be generally recommended. However, MCE has a good predictive value for guiding management toward either endoscopic resection (if technically feasible) or surgical resection.     

食管早癌内镜下黏膜剥离术后追加手术及放疗的握判

目的初步探讨食管早癌内镜下黏膜剥离术(ESD)后追加手术及放疗的评判依据。方法回顾性分析2009年7月-2015年10月,该院消化科112例行ESD治疗的食管早癌患者临床资料、术后病理结果及术后随访结果。结果随访期内共有7例患者进一步治疗,其中追加食管癌根治手术3例;贲门癌根治术1例,术后淋巴结阳性再次追加化疗;追加ESD术1例;放疗2例。7例患者肿瘤浸润至上皮内层(m1)和黏膜下层上1/3(sm1)各3例,浸润至黏膜肌层(m3)者1例。1例患者病理提示脉管内转移,随访13个月胃镜检查局部无复发,但CT提示腹腔淋巴结转移,随访16个月后死亡。另有1例浸润深度达m1的高级别上皮内瘤变(HGIN)患者,垂直及水平切缘均为阴性,随访7个月局部无复发,但CT提示肝及腹膜后淋巴结转移。结论术前准确判断癌灶浸润深度及有无淋巴结转移是决定患者治疗方式的重要依据;术后评估病灶是否达到了治愈性切除,随访有无局部复发及淋巴结、远处转移则决定是否需要追加手术及放疗。     

Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate the efficacy of endoscopic mucosectomy (EM), and to present our experience with the endoscopic removal of superficial tumors of the gastrointestinal tract. PATIENTS AND METHODS: A total of 21 patients were included in the study (16 men, 5 women), between September 1995 and May 1997. In 16 cases the site of the lesions was an esophageal carcinoma, in two cases a gastric carcinoma, and in three cases a sessile polyp of the duodenum with severe dysplasia. Surgery was not recommended for the patients with esophageal or gastric tumors (on account of cardiac disease, cirrhosis or poor health). All patients underwent an endoscopic ultrasound (EUS) examination. The lesions were classified as usT1N0 in 20 cases, and usT0N0 in one case, according to the pretreatment EUS findings. We used the technique of polypectomy after submucosal injection of 10-15 ml of saline serum. RESULTS: Complications were encountered in 2/21 patients (9.5 %). Bleeding occurred in one case, but hemostasis was achieved endoscopically. In the other case, the patient presented with a thoracic pain and was treated by morphine injection. Endoscopic resection was considered to be complete in 19/21 patients (90.4%). In the other two cases, both involving esophageal tumors, histologic examination indicated only a partial tumor removal. However, these two patients had survived with negative EUS and endoscopic biopsy findings at 18 and 22 months later, respectively. None of the patients whose resections were considered complete presented with local recurrence, but three patients developed another superficial esophageal cancer, which was also treated by endoscopic mucosal resection (EMR). The mean follow-up was 20 months. CONCLUSIONS: EMR is a safe and efficient treatment of early gastrointestinal tumors. The development of high-frequency EUS probes may further improve the results of this technique in the future.     

内镜下黏膜切除术与高频电切术治疗消化道无蒂息肉的临床疗效观察

目的观察内镜下黏膜切除术(EMR)与高频电切术治疗消化道无蒂息肉的临床疗效。方法选取该院2017年3月-2019年3月收治的80例消化道无蒂息肉患者作为研究对象,以随机数表法分为EMR组与高频电切术组,每组各40例,EMR组采取EMR治疗,高频电切术组用高频电切术治疗,对比两组总有效率、手术时间、并发症发生率和生存质量评分,统计和比较两组术后随访1年的复发率。结果两组手术时间比较,差异无统计学意义(P 0.05);EMR组与高频电切术组总有效率、并发症发生率和复发率比较(97.50%和90.00%、5.00%和15.00%、2.50%和10.00%),差异均有统计学意义(P 0.05);两组术前生存质量评分比较,差异无统计学意义(P 0.05),两组内术后与术前比较,差异均有统计学意义(P 0.05),两组术后比较,差异有统计学意义(P 0.05)。结论 EMR治疗消化道无蒂息肉较高频电切术疗效更佳,并发症发生率和复发率更低,值得临床推广。     

口袋法内镜黏膜下剥离术对早期结直肠癌及其癌前病变的疗效评价

目的探讨口袋法内镜黏膜下剥离术(ESD)治疗早期结直肠癌及其癌前病变的临床疗效。方法收集2017年4月-2018年12月该院消化内科收治的23例早期结直肠癌及其癌前病变患者,通过口袋法ESD术治疗,记录临床相关数据,进行回顾性分析。结果切下的23例病变最长径1.8~4.5 cm;手术时间为25.0~140.0 min;无术中明显出血及迟发性出血病例;无术中和迟发性穿孔病例;整块切除率为100.0%;术后病理显示,腺瘤伴低级别上皮内瘤变14例,腺瘤伴高级别上皮内瘤变6例,腺瘤伴黏膜内癌2例,水平及垂直切缘均阴性,完全切除率95.7%(22/23),而1例术后病理示腺瘤伴高级别上皮内瘤变,局灶癌变伴黏膜下浸润,垂直切缘阳性,追加外科手术;随访时所有患者未见局部复发和远处转移,治愈性切除率为95.7%。结论口袋法ESD术治疗早期结直肠癌及其癌前病变安全且有效。