抗反流黏膜切除术治疗不伴有食管裂孔疝的难治性胃食管反流病的疗效分析

目的:评价抗反流黏膜切除术治疗不伴有食管裂孔疝的难治性胃食管反流病的临床疗效及安全性。方法:回顾性分析2018年1月至2020年6月苏北人民医院胃肠中心收治的不伴有食管裂孔疝的难治性胃食管反流病28例患者的临床资料,其中采用内镜下黏膜切除术（EMR）16例,内镜黏膜下剥离术（ESD）12例,比较手术前后胃食管反流症状、...     

内镜剥离术治疗食管环周早癌的安全性和疗效评估

目的 探讨内镜黏膜下剥离术（ESD）治疗食管环周早癌（Early Esophageal Cancer,EEC）的疗效价值，评估其治疗安全性。方法回顾性分析在2021年1月至2022年6月于本院接收治疗的食管环周早癌患者，共60例，将患者分为内镜下黏膜剥离术（Endoscopic Submucosal Dissection,ESD）组和内镜黏膜切除术（endoscopic mucosal resection,EMR）组，各30例。其中ESD组采用ESD治疗，EMR组采用内镜下黏膜切除术（EMR）治疗。统计并分析两组患者围手术期指标、术后并发症以及病灶切除情况。结果 围手术期指标比较：ESD组患者手术时间明显高于EMR组，比较差异具有统计学意义（P<0.05），出血量以及住院时间组间比较差异无统计学意义（P>0.05）;ESD组共发生6例（20.00%）术后并发症，与EMR组的8例（26.67%）相当，比较差异无统计学意义（P>0.05）;ESD组的病灶整块、切缘阴性、治愈性切除比例明显优于EMR组，比较差异具有统计学意义（P<0.05）。结论 ESD治疗EEC预后...     

内镜下治疗早期胃癌及癌前病变的安全性分析

目的：探讨内镜下黏膜切除术（ endoscopic mucosal resection , EMR ）和黏膜剥离术（ endoscopic submucosal dissection,ESD）治疗早期胃癌及高级别上皮内瘤变的安全性。方法2009年2月～2014年4月,对胃镜、色素内镜、内镜窄带成像（ narrow band imaging ,NBI）、超声胃镜发现的早期胃癌及高级别上皮内瘤变85例进行EMR或ESD治疗。16例病变位于黏膜层、病灶＜5 mm者行EMR,其余行ESD。结果85例病变均成功切除,其中EMR 16例,ESD 69例。81例（95．3％）整块切除,4例（4．7％）分次切除。80例（94．1％）完整切除,5例（5．9％）病灶残留,其中切缘残留2例,基底部残留3例。手术时间15～69 min,平均40 min。术后病理证实高级别上皮内瘤变34例,黏膜内癌4例,黏膜上皮层癌3例,黏膜固有层癌11例,黏膜肌层癌23例,黏膜下层癌10例。术中出血3例（3．5％）,用氩离子凝固（argon plasma coagulation,APC）、热活检钳电凝或金属止血夹夹闭处理后成功止血。术中穿孔3例（3．5％）,均为ESD治疗者,穿孔直径＜10 mm,均用金属夹成功夹闭;术后迟发型出血7例（8．2％）,口服肾上腺素盐水及静脉药物止血、抑酸等治疗后缓解,无迟发型大出血。追加外科手术8例（9．4％）,其中5例因病灶残留,2例因ESD术后病理结果为病变侵及黏膜下层,无病灶残留,但病理类型为低分化腺癌,1例36岁患者ESD术后病理为中分化腺癌。无死亡病例。结论 EMR、ESD在治疗早期胃癌及高级别上皮内瘤变中完整切除率高,安全性高。     

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.     

经内镜隧道式黏膜下剥离术切除胃黏膜病变的应用报道

目的 内镜黏膜下剥离术(ESD)已经广泛应用于胃癌前病变和早癌等黏膜病变的治疗中,但对于大面积病变,ESD操作方法仍有一定困难。随着隧道技术的发展与应用,我们首次应用经内镜隧道式黏膜下剥离术(ESDTT)切除胃黏膜病变。方法 从2012年8月至2012年9月我院共有4例患者因术前诊断为胃癌前病变或早癌行ESDTT术。4例病变均整块切除,操作时间34~97min,平均65min;切除标本大小4~5cm,平均为4.3cm。结果 术后病理提示高级别上皮内瘤变2例,黏膜内癌2例,病变基底与边缘均未见残留。患者术后均未出现出血、穿孔等并发症。结论 ESDTT切除胃大面积黏膜病变安全可行。     

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内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)作为一种治疗早期胃癌新技术,同样适用于治疗食管胃结合部(esophagogastric junction,EGJ)的浅表癌。ESD治疗食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)及EGJ处癌前病变,与外科剖腹手术及内镜黏膜切除术(endoscopic mucosal resection,EMR)等内镜治疗方法相比,具有明显优势。但ESD治疗EGJ处病变,手术难度较高,手术时间更长,手术并发症发生率更高,对操作者的技术要求较高。     

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。     

胆道造影导管用于黏膜下注射在内镜黏膜下剥离术中的应用

目的探讨利用胆道造影导管进行黏膜下注射减少内镜黏膜下剥离（endoscopicsubmucosaldissection,ESD）术中出血的应用价值。方法将上消化道早期癌或黏膜重度不典型增生而接受ESD术的50例患者随机分两组,术中分别采用传统黏膜注射针和胆道造影导管进行黏膜下注射,统计患者黏膜下注射后引起的出血次数／黏膜下注射次数的比值以及单位面积病灶剥离时间,分析两组间差异是否有统计学意义。结果使用胆道造影管行黏膜下注射的患者注射后出血几率和单位面积黏膜切开所需时间均小于采用传统黏膜注射针组。结论利用胆道造影管进行黏膜下注射有助减少ESD术中出血,缩短ESD手术时间,是值得探索的一种改良方法。     

内镜下黏膜切除术与内镜黏膜下剥离术对早期胃癌疗效的Meta分析

目的：系统评价内镜下黏膜切除术（EMR）与内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）的疗效及安全性。 方法：检索多个国内外数据库,收集相关临床研究文献,筛选出符合纳入标准的合格文献后行Meta分析。 结果：最终纳入15个临床病例对照研究,共4 673例患者,其中ESD组2 154例,EMR组2 519例。Meta分析显示,ESD组的手术时间长于EMR组,但整块切除率、完整切除率、治愈切除率均高于EMR组（均P<0.05）;并发症方面,两组出血的发生率差异无统计学意义（P>0.05）,但ESD组的穿孔发生率高于EMR组（P<0.05）;ESD组术后局部复发率低于EMR组（P<0.05）。 结论：ESD治疗EGC切除率高、局部复发率低,但手术时间长、穿孔率高,但以上结论还需要大样本、高质量的研究进一步证实。     

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。     

Reliability of endoscopic esophageal mucosectomy using TxHood,a multipurpose treatment hood

Endoscopic mucosectomy, comprising both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), is a minimally invasive treatment for patients with early esophageal carcinoma. The use of ESD is appropriate for mucosal lesions of any size. However, ESD techniques are relatively difficult and can lead to serious complications such as perforation and massive bleeding, which have been reported more frequently after ESD than after EMR. This study describes a novel technique for ESD using a newly designed multipurpose treatment hood (TxHood) as well as basic experiments to ensure its safety. The TxHood includes various therapeutic tools such as an electric needleknife, a snare wire, and an injection needle, and the lines can be selected freely before insertion of an enodoscope covered by a TxHood. The main techniques for ESD are endoscopic submucosal saline injections on demand through a working channel of the endoscope or TxHood and a cut or swing cut with a needleknife attached to the TxHood. Moreover, the target area can be grasped with a grasping forceps through a working channel of the endoscope to obtain effective countertraction. In these experiments, an electric needleknife set parallel to the shaft of the endoscope offered safety and ease of handling for the dissecting procedures. Altogether, 16 resections of mucosa with an average size of 3.5 × 2.5 cm (range, 2 × 2 to 7 × 4 cm) were performed. The average time required for each targeted endoscopic resection area was about 15 min. No perforations or instances of uncontrollable bleeding occurred. In conclusion, this basic study demonstrates that the new ESD technique with the TxHood provides a useful treatment for early esophageal carcinoma and may be applicable for all mucosal or submucosal tumors in the gastrointestinal tract. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2006 meeting in Dallas, April 2006, during the New Technology session.     

The modern treatment of early gastric cancer: our experience in an Italian cohort

Background  Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors. However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort. Methods  Forty-five patients for a total of 48 gastric lesions were enrolled in the study. Thirty-six EMR procedures were performed with the strip biopsy technique using a double-channel endoscope. En bloc resection refers to resection in one piece, while piecemeal refers to resections in which the lesion was removed in multiple fragments. A total of 12 ESD were performed and completed with IT knife. We define as curative treatment lateral and vertical margins of the resected specimens free of cancer and repeat endoscopic finding of no recurrent disease. Results  Out of 36 EMR procedures, 10 were piecemeal resections (28%), while 26 were en bloc (72%). ESD led to en bloc resection in 11/12 cases (92%). Histological assessment of curability in the EMR group was achieved in 56% of the cases, and in 92% of the ESD group. Mean follow-up period was 31 months (range: 12–71 months). There was no local recurrence or distant metastasis in the curative group patients. Conclusions  These results seem to confirm the safety and the clinical efficacy of the ESD procedure in the Western world too.     

内镜下黏膜切除术及黏膜剥离术治疗早期胃癌和癌前病变的疗效对比研究

目的对比分析内镜下黏膜切除术（EMR）和内镜下黏膜剥离术（ESD）对治疗早期胃癌（EGC）和癌前病变的效果和安全性。 方法选取2015年1月至2016年1月无锡市第二人民医院收治的60例EGC和癌前病变患者为研究对象，根据治疗方式分为EMR组（32例）和ESD组（28例），对比分析两组患者的手术时间、禁饮禁食时间、术中出血情况、术后病理、整块切除率、治愈性切除率、肿瘤局部复发率、肿瘤残留率和术中、术后不良反应及预后情况。 结果ESD组患者手术时间长于EMR组［（53.35±7.12）min vs（34.23±5.74）min，t=2.009，P=0.043］，术中出血量多于EMR组［（10.26±3.42）ml vs（3.35±0.71）ml，t=2.511，P=0.018］，差异有统计学意义。ESD组患者病灶整块切除率（92.9% vs 62.5%，χ²=7.693，P=0.006）及治愈性切除率（78.6% vs 43.8%，χ²=7.545，P=0.006）均高于EMR组患者，差异有统计学意义。ESD组不良反应率为14.3%（4/28），高于EMR组的3.1%（1/32），差异有统计学意义（χ²=8.765，P=0.001）。两组患者术后2年总生存率比较，差异无统计学意义（χ²=0.643，P=0.423）。 结论与EMR相比，ESD可能是治疗EGC及癌前病变的一种较为安全有效的手术方式。     

Endoscopic approach to patients with portal hypertension: a complex diagnosis

Summary We analyzed the endoscopic findings in 788 patients with esophageal and gastric varices who underwent upper gastrointestinal endoscopy between 1 January 1979 and 31 December 1988. Of these, 154 patients (19.6%) had gastric varices associated in various patterns with esophageal varices. Congestive gastropathy, occurring with esophageal and gastric varices (43.4%), was the most frequent pathology detected in our patients. Esophagitis was present in 15.8% of patients, but did not correlate with variceal bleeding. Endoscopy performed at 1 day to 1 week post-hemorrhage in 313 patients accurately identified the source of bleeding in only 57.2% of patients. This figure increased to 98.2% when we performed the examination within the first 24 h of hemorrhage. In this group varices were the source of hemorrhage in 72.3% of patients while the hemorrhage came from other sources, such as erosive gastritis, duodenal and gastric ulcer in 27.6% of patients.     

Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives

Background Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique. Methods In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins. Results From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy. Conclusions Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Gastric bleeding after endoscopic injection sclerotherapy for esophageal varices may be fatal.

Among 457 Japanese cirrhotic patients with esophageal varices, 28 (6%) bled from the upper gastrointestinal tract after the initial session of endoscopic injection sclerotherapy (EIS); 13 bled during the course of repeated EIS and 15 bled mainly from gastric lesions after eradication of the varices. Of these 28 patients, bleeding from gastritis occurred in 13 (46%), from esophageal varices in 10 (36%), from gastric varices in 4 (14%) and from gastric ulcer in one (4%). Six of 13 patients with gastritis-related bleeding and 3 of 4 patients with gastric variceal bleeding died of uncontrollable hemorrhage complicated liver failure, while 9 of 10 patients with esophageal variceal bleeding were controlled and reinjection was feasible. Ten (36%) of the 28 patients, with Child's grade B or C and severe ascites, died, mainly following bleeding from gastric lesions. This study shows that bleeding from gastric lesions after EIS can be uncontrollable and fatal in patients with poor liver function.