Clinical efficiency of endoscopic submucosal dissection in treatment of gastrointestinal neoplasms / 中国内镜杂志

ABSTRACT

Objective To discuss the clinical efficiency of endoscopic submucosal dissection (ESD) in treatment of early gastric cancer (EGC) and precancerous lesions. Method Clinical data of 106 patients with EGC or precancerous lesions who received the treatment of ESD from June 2012 to June 2015 was collected. Then analyzing the treatment effect, complications, postoperative pathology and long-term efficacy of ESD. Results The overall en bloc resection rate was 100.0％, the mean operation time was (61.8 ± 17.3) min and the mean diameter of the lesions was (2.7 ± 1.3) cm. No endoscopic massive haemorrhage occurred; The incidence of perforation and postoperative delayed bleeding was 6.6％ and 5.7％ respectively, which were cured by endoscopic treatment and there was no surgical treatment. Postoperative pathological results showed high differentiated adenocarcinoma in 23 cases, moderately differentiated adenocarcinoma in 29 cases, poorly differentiated adenocarcinoma in 19 cases, signet ring cell carcinoma in 3 cases and high grade intraepithelial neoplasia in 32 cases. Among them, 7 cases with basal tumor invasion, and there were no margin positive cases. So the R0 resection rate was 93.4％ and the R1 removal rate was 6.6％. The 7 cases with R1 resection reached R0 resection after second endoscopic treatment. 5 cases recurred within 1 years after the operation, and the recurrence rate was 4.7％. Up to December 2016, 3 patients died, the median follow-up period was 34 months and the 3 year survival rate was 97.9％. Conclusion ESD is safe and feasible in the treatment of EGC and precancerous lesions with the advantages of less trauma, faster recovery, less complications and reliable curative effect. Its clinical efficiency is similar to surgery.