消化道类癌三种内镜治疗方法的比较

目的比较普通圈套器电切、内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗消化道类癌的有效性和安全性。 方法回顾性分析2006年1月至2015年6月病理符合消化道类癌患者的临床资料,比较普通圈套器电切治疗(普通圈套器电切组,12例)、内镜黏膜切除术治疗(EMR组,47例)和内镜黏膜下剥离术治疗(ESD组,39例)的组织学完全切除率、并发症,以及术后随访6～36个月观察其疗效。 结果内镜治疗消化道类癌的组织学完全切除率为78.57%(77/98)。普通圈套器电切组的组织完全切除率为66.67% (8/12),EMR组为82.98% (39/47),ESD组为76.92% (30/39),差异均无统计学意义 (P＝0.463)。仅1例ESD治疗后发生穿孔,其他患者未出现并发症。所有患者随访6～36个月,均未复发。 结论内镜治疗对病变未超过黏膜下层的小的消化道类癌是一种安全有效的方法。     

ESD治疗结直肠早癌及癌前病变30例疗效观察

目的:观察内镜黏膜下剥离术(ESD)治疗结直肠早癌及癌前病变的疗效。方法:将60例结直肠早癌及癌前病变患者随机分为观察组和对照组,每组30例。观察组患者采用ESD治疗,对照组患者采用内镜下黏膜切除术(EMR)治疗,比较2组患者手术指标、手术切除情况及术后并发症发生情况。结果:观察组患者手术时间、标本直径均长于对照组(P<0.05),术中出血量、标本厚度均多于对照组(P<0.05);观察组患者整体切除、完全切除率高于对照组(P<0.05),不完全切除率低于对照组(P<0.05);观察组患者术后并发症发生率低于对照组(P<0.05)。结论:ESD治疗结直肠早癌及癌前病变可减少术后并发症的发生,提高病变组织切除率。     

EMR-C及ESD在直肠神经内分泌肿瘤治疗中的应用效果比较

目的比较透明帽辅助内镜下黏膜切除术(EMR-C)及内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤的效果。方法回顾性分析2012年10月至2017年10月在本院内镜中心就诊并行内镜下切除治疗的直径10 mm的52例直肠神经内分泌肿瘤患者病历资料,根据手术的方式分为EMR-C组(n=29)和ESD组(n=23),比较两组手术时间、完整切除率、术后并发症发生率以及复发情况。结果两组患者年龄、肿物大小及距肛缘距离、完整切除率差异均无统计学意义(均P0.05),EMR-C组手术时间较ESD短(P0.05),ESD组有2例出现术后迟发性出血,两组均没有出现穿孔病例。结论直肠神经内分泌肿瘤患者应用EMR-C与ESD行内镜下治疗,两者的完整切除率相当,但前者手术时间更短,术后并发症更少,可以作为内镜下治疗直肠神经内分泌肿瘤的优先选择。     

内镜下黏膜切除术和内镜黏膜下剥离术对于早期胃癌治疗效果的对比研究

目的比较内镜下黏膜切除术(Endoscopic mucosal resection,EMR)和内镜黏膜下剥离术(Endoscopic submucosal dissection,ESD)对于早期胃癌治疗效果,供临床参考。方法选取2016年1月至2017年12月本院收治的160例早期胃癌患者作为研究对象,其中80例行EMR术,另外80例行ESD术。比较EMR组与ESD组的大块切除率、完全切除率、治愈性切除率、局部复发率、手术时间、出血发生率和穿孔发生率。结果 EMR组的大块切除率、完全切除率和治愈性切除率均低于ESD组,差异具有统计学意义(P0.05);EMR组的局部复发率高于ESD组,差异具有统计学意义(P0.05);EMR组的手术时间较ESD组短,差异具有统计学意义(P0.05);EMR组与ESD组的出血发生率和穿孔发生率差异均无统计学意义(P0.05)。结论与EMR相比,ESD具有更好的切除效果,降低了局部复发率,是治疗早期胃癌的较好选择。     

内镜下套扎术(EVL)治疗胃肠道黏膜下病变疗效及安全性观察

目的观察内镜下套扎术(EVL)治疗胃肠道黏膜下病变的安全性及疗效。方法将85例(102处黏膜下病变)行内镜下套扎术的患者设为观察组,将同期72例(85处黏膜下病变)行内镜黏膜下剥离术(ESD)的患者作为对照组,回顾性比较2组患者术中出血情况及穿孔发生率。随访6个月,复查病变消除情况。结果 2组手术成功率均为100%。观察组术中出血发生率、穿孔发生率及住院时间均低于对照组,差异有统计学意义(P0.05)。6个月后门诊内镜复查,观察组痊愈率为97.65%,对照组为100%,差异无统计学意义(P0.05)。结论 EVL治疗胃肠道黏膜下病变可达到与EMR相同的疗效,但术中出血少,患者住院时间短,是安全微创的方法,但应用时要严格掌握适应证。     

内镜隧道式黏膜下剥离术治疗大面积早期食管癌的安全性和有效性评价

目的评价内镜隧道式黏膜下剥离术(endoscopic submucosal tunnel dissection,ESTD)用于治疗大面积早期食管癌的安全性和有效性。 方法回顾性分析2018年1月至2019年8月于解放军总医院第一医学中心消化内科接受内镜下手术治疗的共68例大面积早期食管癌患者资料,根据手术方式不同,分为内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)组45例和ESTD组23例。对比分析ESD组与ESTD组在术中出血、穿孔、剥离速度、治愈性切除率的表现。 结果安全性,ESD组1例(2.2%)术后出现迟发性出血,ESTD组2例(8.7%)发生迟发性出血,该3例出血患者通过热止血钳电凝处理均成功止血,两组相比,差异无统计学意义(P＝0.545)。ESD组无穿孔出现;ESTD组1例发生术中穿孔,以钛夹及生物蛋白胶有效封堵穿孔,两组相比,差异无统计学意义(P＝0.730)。有效性,ESD组40例(88.9%)实现治愈性切除,ESTD组21例(91.3%)达到治愈性切除,两组相比,差异无统计学意义(P＝1.000)。ESD组病变剥离速度为(33.2±13.4)mm²/min,ESTD组病变剥离速度为(41.8±17.3)mm²/min,两组相比,ESTD组要显著快于ESD组(P＝0.027)。 结论与传统ESD相比,ESTD对于病变黏膜剥离速度更快,是一种安全有效的治疗大面积早期食管癌的内镜下切除术式。     

内镜黏膜下剥离术与外科切除治疗早期残胃癌长期疗效的比较研究

目的本研究旨在对内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与外科手术切除治疗胃癌外科R0切除术后早期残胃癌(early remnant gastric cancer,ERGC)的远期疗效进行比较。 方法收集2008年1月至2016年12月就诊于解放军总医院的胃癌外科R0切除术后经内镜活检诊断为ERGC患者的临床和病理资料,根据患者接受治疗措施的不同将其分为ESD治疗组和外科手术组,在2020年5月对所有患者进行电话随访。计算ESD治疗组的整块切除率、完全切除率、治愈性切除率。采用Kaplan-Meier法计算ESD组和外科手术组患者5年总生存率和病因特异性生存率,采用Log-Rank检验比较ESD组和外科手术组患者生存率的差异。 结果共纳入ERGC患者32例,其中ESD组21例、外科手术组11例。32例ERGC患者中男性31例(96.9%)。ESD治疗组的整块切除率76.2%(16/21)、完全切除率71.4%(15/21)、治愈性切除66.7%(14/21)。ESD组及外科手术组5年总生存率差异无统计学意义(78.8%比77.1%,P＝0.764),5年病因特异性生存率差异无统计学意义(78.8%比90.0%,P＝0.538)。 结论残胃空间有限及黏膜下严重纤维化都增加了ESD的难度,但ESD与外科手术切除治疗ERGC患者的长期疗效相当,ESD可作为ERGC的一种安全、有效的治疗选择。     

食管胃交界部固有肌层来源黏膜下肿瘤内镜下切除方法的选择与评价

目的评价以内镜黏膜下剥离术（ESD）为基础的各种内镜切除技术在食管胃交界部（EGJ）固有肌层来源黏膜下肿瘤（SMT）治疗中的临床价值和适应证的选择。方法回顾性分析复旦大学附属中山医院内镜中心所有接受内镜下切除治疗的患者资料库．筛选出2007年3月至2011年6月间经内镜下超声或CT证实固有肌层来源的EGJ处SMT患者143例。详细记录患者的临床病理资料、内镜切除方法、完整切除率、并发症发生率及术后随访资料。结果143例患者中男74例,女69例,平均年龄49．1岁。135例（94-4％）病变成功完成内镜下整块切除,其中接受内镜黏膜下挖除术126例,无腹腔镜辅助的内镜全层切除术6例,内镜经黏膜下隧道肿瘤切除术3例：另外8例肿瘤于内镜下部分切除后,基底部尼龙绳套扎。肿瘤平均直径为17．6mm．平均手术时间45．1min．平均出血量50．0ml。术中穿孔6例,贲门黏膜撕裂1例。均通过内镜下处理及保守治疗好转。术后病理示,平滑肌瘤121例,胃肠间质瘤20例。颗粒细胞瘤1例．肌间脂肪瘤1例。术后经3。48个月的随访,未见局部复发和远处转移病例。结论在EGJ固有肌层来源SMT治疗中．各种内镜切除方法均安全有效．临床医师需根据肿瘤的临床特征具体选择．     

内镜黏膜下剥离术治疗消化道黏膜下肿瘤

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效和安全性。方法对内镜发现的19例消化道SMT(食管6例,胃6例,十二指肠1例,乙状结肠1例,直肠5例)进行超声内镜检查(18例病变位于黏膜下层,1例位于固有肌层),应用头端弯曲的针形切开刀进行ESD治疗。黏膜下注射生理盐水抬高病变,使病变与肌层相分离,预切开病变周围黏膜,剥离病变下方黏膜下层结缔组织,完整切除病变。结果病变最大直径0.5～3.0cm(平均1.6cm)。18例成功完成ESD治疗,手术时间15～105min(平均45min)。2例ESD术中出现内镜难以控制的大出血,1例成功保守治疗(三腔管食管囊压迫),1例转开腹手术。无术后出血。ESD穿孔3例:2例术中消化道穿孔(十二指肠球部和胃底),应用金属夹缝合成功,未转开腹手术;1例直肠类癌剥离深至肌层,术后出现皮下气肿,保守治疗气肿减退。所有ESD剥离病变包膜完整,基底和切缘未见病变累及。结论ESD治疗消化道SMT安全、有效,可以完整切除消化道黏膜下层病变,提供完整的病理诊断资料。对于来源于固有肌层的SMT,应慎行ESD。     

内镜下治疗胃肠道神经内分泌肿瘤40例

目的评价超声内镜及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃肠道神经内分泌肿瘤(gastrointestinal neuroendocrine neoplasms,GI-NENs)的临床价值。方法我院2011年5月~2016年5月采用ESD治疗GI-NENs 40例(食管1例,胃2例,十二指肠1例,阑尾1例,结肠2例,直肠33例),先在内镜下对病灶边缘进行环形标记,然后用甘油果糖靛胭脂肾上腺素稀释液黏膜下注射后环周切开,最后沿固有肌完整剥离切除肿物。结果 40例术前超声内镜检查病变均局限于黏膜层至黏膜下层,术后病理示1例侵及肌层,超声内镜术前判断病变累及层次的正确率为97.5%(39/40)。术中术后无出血、穿孔等并发症。术后病理完整切除率为97.5%(39/40),G1级34例,G2级6例。33例随访平均30.4月(2~56个月),均未见局部复发和远处转移。结论 GI-NENs好发于直肠,以G1和G2级常见。ESD是治疗高分化神经内分泌瘤安全有效的方法,超声内镜能有效指导手术方案的选择。     

Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary portion.METHODS This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were investigated.RESULTS Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.     

十二指肠Brunner腺瘤的内镜治疗

目的探讨十二指肠Brenner腺瘤内镜治疗的价值。方法回顾性分析2006年11月至2011年5月间复旦大学附属中山医院内镜中心行内镜治疗且经病理证实的29例十二指肠Brunner腺瘤患者的临床资料。结果29例患者中男性13例,女性16例,中位年龄为55（29-72）岁。病灶大小（1．7±0．1）cm,其中0．5-1．0cm17例。1．0-2．0cm6例,大于2．0cm6例。无蒂隆起性病灶18例;有蒂病灶11例,其中粗蒂3例,亚蒂2例。内镜治疗中采取圈套电切9例（其中3例外加尼龙绳结扎）,内镜黏膜切除术12例,内镜黏膜下剥离术8例,均获完整切除。术中出血1例约200ml,经多枚金属夹夹闭和尼龙绳圈套后成功止血;术中穿孔1例,予金属夹夹闭：术后第2天发生迟发性出血1例,行内镜止血。全组术后随访2。39（中位数13）个月,生活质量较好,未见任何远期并发症。术后1年复发1例。再次予内镜黏膜下剥离术治疗。结论内镜治疗对于Brunner腺瘤是一种安全、有效的治疗方法。     

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??Clinical efficacy of endoscopic resection of duodenal papilla tumor?? A report of 36 cases QI Zhi-peng*, SUN Di, ZHOU Ping-hong, et al. *Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: ZHONG Yun-shi. E-mail: zhong.yunshi@zs-hospital.sh.cn
Abstract Objective To evaluate therapeutic effect of endoscopy on duodenal papilla tumor, and the prevention and treatment methods of its complications. Methods The clinical data of 36 patients underwent the endoscopic duodenal papilla tumor resection in Zhongshan Hospital of Fudan University from January 2010 to May 2017 were studied retrospectively. Results A total of 36 patients underwent 38 procedures successfully. Among 29 cases without postoperative metallic clips closured, perforation occurred in 1 case (3.4%), delayed bleeding occurred in 5 cases (17.2%), postoperative pancreatitis occurred in 3 cases (10.3%), biliary ducts inflammation occurred in 2 cases (6.9%), and pancreaticobiliary strictures occurred in 1 case (3.4%). Among 9 cases of postoperative metallic clips closured, there was no delayed bleeding, perforation, and postoperative pancreatitis; biliary ducts inflammation occurred in 1 case (11.1%), and pancreaticobiliary strictures occurred in 1 case (11.1%). After following up 30.5(1.0~85.0)months, there were 2 recurrent patients, and both were treated by endoscopy. Conclusion Endoscopic treatment of duodenal papilla tumor may be effective. The incidence of complication is high, but postoperative clips closured may reduce the complications.     

原发性十二指肠恶性肿瘤的外科治疗

目的探讨原发性十二指肠恶性肿瘤的外科治疗策略。方法回顾性分析1997~2004年我院收治的72例原发性十二指肠恶性肿瘤病人的临床资料。52例行胰十二指肠切除术,8例行肿瘤局部切除术,5例行胆肠和/或胃肠吻合术解除梗阻,4例行肿瘤活检术以明确诊断,3例确诊后拒绝手术治疗。结果随访62例。46例行胰十二指肠切除术病人术后1年、3年和5年的生存率分别为76.1%,54.3%和28.3%。3例放弃手术治疗者及3例行肿瘤活检术者均于1年内死亡。4例仅行胆肠和/或胃肠吻合术者术后1年生存率为25%。6例行肿瘤局部切除术者均于术后短期内复发,仅2例存活1年。52例行胰十二指肠切除术病例中出现并发症的有8例。应用单层褥式交锁缝合进行胰肠重建的20例及保留幽门的8例术后经过均良好,无1例出现严重并发症。结论胰十二指肠切除术系原发性十二指肠恶性肿瘤的首选治疗方法,应严格掌握肿瘤局部切除术的适应证。     

Effect of non-curative endoscopic submucosal dissection on short-term outcomes of subsequent surgery for early gastric cancer

BackgroundWith growing incidence of early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is widely performed as a standard treatment for mucosal cancer. Due to the increasing application of ESD, the number of non-curative resection after ESD is also growing, leading to escalating number of patients who require additional gastrectomy with lymph node dissection after non-curative ESD. However, effects of ESD prior to surgery on technical difficulties during operation for EGC remain unclear. Therefore, this study aimed to determine the effect of non-curative ESD on short-term surgical outcomes in patients who underwent additional surgical treatment using propensity score matching method.MethodsTo evaluate the effect of ESD on short-term surgical outcomes in patients who underwent additional surgical treatment after a non-curative ESD procedure, patients were divided into two groups: (1) those who underwent additional gastrectomy after non-curative resection of ESD [ESD + Surgery (ES) Group], and (2) those who underwent gastrectomy as the initial treatment [Surgery Only (SO) Group]. To minimize differences in baseline demographic features that could potentially be associated with short-term outcomes, propensity-scored matching analysis was performed.ResultsAfter propensity-scored matching (1:1 matching), 140 patients altogether were selected and analyzed in this study. Complications were experienced by 18 (25.7%) patients in the ES group and 13 (18.6%) patients in the SO group, showing no significant (p < 0.416) difference between the two groups.ConclusionsAdditional surgery after non-curative ESD can be safely applied, even within one month after ESD in terms of short-term complications.     

消化道类癌内镜治疗方法的比较

目的 比较内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）、内镜下黏膜切除术（endoscopic mucosal resection,EMR）和深凿活检钳除术治疗消化道类癌的效果.方法 回顾性分析我院2007年1月-2012年12月经病理确诊的49例消化道类癌的临床资料,结合超声内镜检查表现,比较ESD（n=25）、EMR（n=16）和内镜深凿活检钳除（n=8）治疗消化道类癌的组织学完全切除率、并发症及内镜随访情况.结果 内镜治疗消化道类癌的组织学完全切除率为59 2%（29/49）.ESD组的组织完全切除率76.0%（19/25）明显高于EMR组43.8%（7/16）和深凿活检钳除组37.5%（3/8）,差异有统计学意义（P=0.048）,其中ESD组组织完全切除率明显高于EMR组（χ^2=4.374,P=0.036）.直径≥1 cm的11例类癌中,4例（36.4%）组织学不完全切除.组织学不完全切除的20例中,仅3例术前进行了超声内镜检查,占超声内镜检查的15.0%（3/20）;组织学完全切除的29例中,17例进行了超声内镜检查,占超声内镜检查85.0%（17/20）.1例ESD治疗后发生出血,其余患者未出现并发症.22例（44.9%,22/49）随访1-23个月（平均10.4月）,均未复发.结论与EMR相比,ESD在组织完全切除方面更具有优势.超声内镜检查对于术前评估具有重要意义.     

原发性十二指肠癌的临床特征与手术治疗

目的 提高原发性十二指肠癌的诊断与治疗水平。方法 回顾性分析我院1987-2000年间收治的45例原发性十二指肠癌的临床资料。结果 乳头周围区癌64.5％（29/45）,乳头下部癌占22.2％（10/45）,乳头上部癌占13.3％（6/45）。十二指肠镜的确诊率为71.4％（15/21）。胰十二指肠切除术22例,节段性肠切除术2例,单纯癌肿切除术3例,胃肠、胆肠吻合术12例,剖腹探查术4例,手术切除率为62.8％（27/43）。结论 原发性十二指肠癌以乳头周围区癌多见。手术以胰十二指肠切除术为主,节段性肠切除术和单纯癌肿切除术根据具体情况可酌情应用。     

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??Therapeutic effect analysis of colorectal polyps with diameter≥2.5cm treated by endoscopic submucosal dissection: A report of 567 cases LI Ran, CAI Shi-lun, SUN Di, et al. Endoscopy Center??Zhongshan Hospital?? Fudan University,Shanghai 200032,China
Corresponding author: ZHONG Yun-shi, E-mail??13564623481@126.com
Abstract Objective To evaluate the effectiveness of endoscopic submucosal dissection (ESD) in treating colorectal polyps with diameter≥2.5cm. Methods The clinical data of 567 cases of colorectal polyps with diameter≥2.5cm treated by ESD at Endoscopy Center??Zhongshan Hospital??Fudan University between January 2007 and November 2016 were analyzed retrospectively. The data included clinical and pathological characteristics, complications and follow-up. Results Of all lesions, the median diameter was 3.0cm (2.5 to 15.0). Among them, 448 lesions??79.0%?? were high grade intraepithelial neoplasia, and the other 119 lesions ??21.0%??were intra-adenoma adenocarcinoma, focal cancerization or adenocarcinoma. The complete resection rate during operation was 99.1% (562/567). The en bloc resection rate was 78.3% (444/567), and the curative resection rate was 90.8% (515/567). Additional surgeries or endoscopic treatment were performed in 31 cases after ESD treatment. Postoperative bleeding occurred in 3.7% (21/567) of all cases. Penetration and electrocoagulation syndrome after ESD occurred in 1.2% (7/567) and 5.3% (30/567) of cases respectively. The median length of follow-up was 40 (12-90) months, with a local recurrence rate of 1.1% (6/536). Intraoperative complications were related to lesions ≥5.0 cm (P<0.001) and non-en bloc resection (P=0.034). Electrocoagulation syndrome was related to lesions ≥5.0 cm (P=0.004). Postponed bleeding after ESD was related to hypertension (P=0.008). Local recurrence was related to lesions ≥5.0 cm (P=0.037). Conclusion Treating colorectal polyps ≥2.5 cm with ESD is safe and feasible, resulting in high rate of curative resection and an extremely low local-recurrence rate. However, polyps≥5.0 cm showld be cautionly evaluated before ESD.     

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??Endoscopic submucosal dissection for the treatment of foregut neuroendocrine tumors LI Quan-lin??YAO Li-qing??XU Mei-dong??et al. Endoscopy Center and Endoscopy Research Institute??Zhongshan Hospital??Fudan University??Shanghai 200032, China
Corresponding author??ZHOU Ping-hong??E-mail??zhou.pinghong@zs-hospital.sh.cn
Abstract Objective To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine neoplasm(NENs). Methods A total of 24 patients with confirmed histological diagnosis of foregut NENs performed ESD from April 2008 to December 2010 in Zhongshan Hospital of Fudan University were included. Tumor features, clinicopathological characteristics, complete resection rate, complications and follow-up results were evaluated. Results Those treated by ESD included 24 patients with 29 foregut NENs. The locations of the 29 lesions were as follows: esophagus (n=1), cardia (n=1), stomach (n=23), and duodenal bulb (n=4). All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range 2-30 mm), and the procedure time was 20.3 min (range 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%). The remaining patient with NEC underwent additional surgery because of incomplete resection. Delayed bleeding occurred in 1 case after ESD, which was managed by endoscopic treatment. During a mean follow-up period of 24.4 months (12-48 months), local recurrence occurred in only 1 patient after initial ESD. The patient underwent repeat ESD successfully. Metastasis to lymph nodes or distal organs was not observed in any patient. Conclusion ESD appears to be a safe, feasible and effective procedure for providing accurate histopathological evaluations as well as curative treatments for eligible foregut NENs.