上消化道黏膜下肿瘤(主要包括腔外黏膜下肿瘤)内窥镜全厚切除术的可行性和安全性(附视频

IF 5 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive Endoscopy Pub Date : 2024-09-10 DOI:10.1111/den.14918
Yingjie Guo, Fan Yin, Xingsi Qi, Peng Zhang, Xueguo Sun, Xueli Ding, Xiaoyu Li, Xue Jing, Yueping Jiang, Zibin Tian, Tao Mao
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引用次数: 0

摘要

目的内镜下黏膜下肿瘤(SMT)全厚切除术(EFTR)在技术上具有挑战性。这项回顾性研究旨在评估 EFTR 治疗上消化道(GI)黏膜下肿瘤(包括腔外病变)的可行性、安全性和有效性。对所有患者的临床病理特征、手术相关参数、不良事件(AEs)和随访结果进行了评估。结果全层切除率和全层R0切除率分别为98.7%和96.1%。内镜下肿瘤平均大小为 17.2 ± 8.7 毫米,范围为 6 至 50 毫米。切除时间和缝合时间分别为(49.0 ± 19.4)分钟和(22.5 ± 11.6)分钟。总共有 39 个病灶(16.8%)主要表现为腔外生长。胃肠道间质瘤(GIST)是主要病理类型,占病例总数的78.4%。21名患者(9.1%)出现了并发症,包括气胸(1/232,0.43%)、气胸积水(1/232,0.43%)、局部腹膜炎(3/232,1.29%)和发热(16/232,6.9%)。虽然以腔外为主组的术后发热发生率(7/39,17.9%)明显高于以腔内为主组(9/193,4.7%,P = 0.008),但 EFTR 手术的结果并无显著差异。结论发现,EFTR 是切除上消化道 SMT(包括以腔外生长为主的病变)的可行、安全且有效的方法。需要在前瞻性研究中进一步验证。
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Feasibility and safety of endoscopic full‐thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video)
ObjectivesEndoscopic full‐thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.MethodsWe retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure‐related parameters, adverse events (AEs), and follow‐up outcomes were assessed in all patients.ResultsThe en‐bloc resection and en‐bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty‐one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow‐up period of 3.7 ± 2.3 years.ConclusionEFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.
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来源期刊
Digestive Endoscopy
Digestive Endoscopy 医学-外科
CiteScore
10.10
自引率
15.10%
发文量
291
审稿时长
6-12 weeks
期刊介绍: Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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