Résumé
Se presenta una pequeña revisión de la literatura sobre el tema de las polipectomías y la endoscopia terapéutica, precursoras de procedimientos mayores endoscópicos como son las mucosectomías. Al final se muestra un caso clínico importante dentro de la endoscopia terapéutica esofágica, tratado por uno de los autores en la Clínica Cordillera de Santiago de Chile...
Sujets)
Endoscopie , Oesophage , PolypesRésumé
Background: Endoscopic mucosectomy is a routine treatment mode for benign and malignant gastric lesions. The prognosis of patients with endoscopically treated early gastric cancer does not differ from patients subjected to surgical gastrectomy, when the indications for endoscopic mucosectomy are respected. Aim: To report the experience in endoscopic mucosectomy for early gastric cancer. Patients and methods: Between 1990 and 1997, 12 lesions in 10 patients, aged 48 to 107 years old, were treated with endoscopic mucosectomy. Clients were followed for 1 to 72 months after the procedure. Results: Treated lesions ranged in size from 7 to 20 mm. Ten patients had differentiated carcinomas, one had an undifferentiated carcinoma and one had a primary gastric carcinoid. Endoscopic appearance was II a in six lesions, II c + II a in two, II a + II c in one. II c in one, I in one and II c + III in one. In two patients, the tumor persisted and were subjected to oncologic surgery. In one of these, no malignant lesion was recognized in the pathological specimen. The other patient had a multicentric carcinoma that was already detected by endoscopy. Neither had lymph node metastases. Endoscopical and pathological follow up in the other 8 patients has not shown persistence or reappearance of malignant lesions during a follow up ranging from 3 to 72 months. Conclusions: Endoscopic mucosectomy can be a valuable therapeutic alternative in early gastric cancer
Sujets)
Humains , Adulte d'âge moyen , Tumeurs de l'estomac/chirurgie , Muqueuse gastrique/chirurgie , Tumeurs de l'estomac/anatomopathologie , Biopsie , Tumeur carcinoïde/chirurgie , Tumeur carcinoïde/anatomopathologie , Endoscopie gastrointestinale , Invasion tumorale/anatomopathologieRésumé
Se discute el caso de una mujer de 91 años portadora de la enfermedad del Nodo, que fue diagnosticada de un cáncer gástrico precoz antral tipo III+IIc. Rechazó ser sometida a cirugía resectiva. Se intentó terapia local ablativa con APC (Argón Plasma Coagulator) como terapia paliativa/curativa? con excelente resultado. Las biopsias sobre la cicatriz fueron negativas para neoplasia en los controles posteriores. Se discute las opciones terapeúticas no quirúrgicas para el tratamiento del cáncer gástrico precoz. (Resección mucosa endoscópica -musectomía- como también la ablación eléctrica, mediante láser o APC)
Sujets)
Humains , Femelle , Sujet âgé , Ablation par cathéter/méthodes , Argon , Tumeurs de l'estomac , Argon , Soins palliatifs , Coagulation par laser/méthodes , Électrocoagulation/méthodes , Endoscopie , Tumeurs de l'estomacRésumé
To analyze the clinical presentation, pathological aspect and trealment of gastric adenomas, a retrospective analysis of 75 patients aged 26 to 88 years in whom a gastric adenoma was diagnosed. Seventy one patients had elevated endoscopical lesions and two had depressed or flat lesions. Ninety percent of lesions were located in the gastric antrum. Pathological study detected 6 focal carcinomas within the adenomas and 5 concomitant carcinomas located elsewhere in the stomach. Fifty four patients were subjected to endoscopical resection. Among patients with focal carcinomas, a gastrectomy was performed in four and endoscopical resection in two. Gastric adenomas must be considered in the differential diagnosis of gastric elevated lesions and may be confused in early gastric cancer. There is a histological resemblance between adenomas and gastric dysplasia descibed by several authors though only in our cases and in the Japanese literature the adenoma is referred to as mostly a polypoid sessile lesion