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Safety and histologic outcomes of endoscopic submucosal dissection with a novel articulating knife for esophageal neoplasia.
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2019-12-20 , DOI: 10.1016/j.gie.2019.12.016
Juan Reyes Genere 1 , Harshith Priyan 1 , Tarek Sawas 1 , Yuri Hanada 1 , Kavel Visrodia 2 , Liam Zakko 3 , Prasad G Iyer 1 , Louis Michel Wong Kee Song 1 , Kenneth K Wang 1
Affiliation  

BACKGROUND AND AIMS Treatment of large esophageal neoplasia is gradually evolving from piecemeal to en bloc resections. Endoscopic submucosal dissection (ESD) is known to achieve more complete resections than piecemeal EMR for large lesions, yet it remains underused in the West because of technical and safety concerns with traditional electrosurgical knives. We aimed to evaluate a novel endoscopic articulating knife used with ESD (ESD-AR) to determine its safety and efficacy for large esophageal neoplasms in comparison with EMR. METHODS We retrospectively studied clinically indicated cases of ESD-AR and EMR for esophageal lesions that were 15 mm or greater. All EMR cases had at least 3 simultaneous EMRs to adequately compare resection area. Rates of perforation, GI bleeding, technical performance, and pre- and postendoscopic resection diagnoses were evaluated. RESULTS Seventy-two ESD-AR and 72 widespread EMR cases were evaluated for Barrett's esophagus (56%), adenocarcinoma (36%), squamous nodularity (2%), and squamous cell carcinoma (6%). There were no statistical differences in age, sex, Barrett's esophagus length, and lesion or resection size between the 2 groups. No perforations occurred. Two adverse events were recorded with ESD-AR and none with EMR (3% vs 0%, P = .50); these were associated with anticoagulation use (P = .04) and greater resection area (P = .02). There were more upgraded diagnoses post-ESD versus EMR (27% vs 12%, P = .05). CONCLUSIONS ESD-AR by an experienced endoscopist has a comparable safety profile with widespread EMR for large esophageal neoplasia and may have advantages for diagnostic staging.

中文翻译:

内镜下黏膜下剥离的安全性和组织学结果与新型铰接刀食管肿瘤。

背景与目的大食管瘤形成的治疗正逐渐从零碎发展到整块切除。内镜下黏膜下剥离术(ESD)的切除效果比零碎EMR更为完整,但由于传统电外科刀的技术和安全性考虑,它在西方仍未得到充分利用。我们旨在评估一种与ESD(ESD-AR)配合使用的新型内窥镜铰接刀,以确定其与EMR相比对大型食道肿瘤的安全性和有效性。方法我们回顾性研究了食管病变为15 mm或更大的ESD-AR和EMR的临床指征病例。所有EMR病例至少有3个同时发生的EMR,以充分比较切除区域。穿孔率,胃肠道出血,技术性能,并评估了内镜和镜下切除术的诊断。结果对72例ESD-AR和72例广泛的EMR病例进行了Barrett食管(56%),腺癌(36%),鳞状结节(2%)和鳞状细胞癌(6%)的评估。两组之间的年龄,性别,巴雷特食管长度以及病变或切除尺寸均无统计学差异。没有穿孔发生。ESD-AR记录了两个不良事件,EMR记录了两个不良事件(3%vs 0%,P = 0.50);这些都与抗凝治疗有关(P = .04)和更大的切除面积(P = .02)。与EMR相比,ESD后的诊断水平更高(27%比12%,P = 0.05)。结论经验丰富的内镜医师进行的ESD-AR具有相当的安全性,广泛适用于大型食管肿瘤的EMR,并且可能在诊断分期方面具有优势。
更新日期:2019-12-20
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