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Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

World Journal of Gastroenterology 2011年第13期17卷 1701-1709页

作者： Sadettin Hulagu Omer Senturk Cem Aygun Orhan Kocaman Altay Celebi Tolga Konduk Deniz Koc Goktug Sirin Ugur Korkmaz Ali Erkan Duman Neslihan Bozkurt Gokhan Dindar Tan Attila Yesim Gurbuz Orhan TarcinDivision of Gastroenterology Derince State Hospital kocaeli 41900 Turkey Cem Kalayci Division of Gastroenterology Kocaeli University Medical School Kocaeli 41000 Turkey Division of Gastroenterology American HospitalIstanbul 34365 Turkey Department of Pathology Kocaeli UniversityMedical School Kocaeli 41000 Turkey Division of Gastroenterology Marmara University School of Medicine Altunizade Istanbul 34662 Turkey

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

关键词：胃肠道大肠癌早期病变膜下内镜剥离计算机断层扫描

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