Effects of endoscopic submucosal tunnel dissection for esophageal superficial neoplasms

doi:10.3877/cma.j.issn.1674-6899.2016.04.014

Abstract

Abstract:

Objective

To evaluate the efficiency and safety of endoscopic submucosal tunnel dissection (ESTD) for esophageal superficial neoplasms.

Method

After stratification by circumferential lesion sizes (i.e. < 1/3 circumference, 1/3-2/3 circumference, > 2/3 circumference), a total of 74 patients who underwent endoscopic resection for esophageal superficial neoplasms were randomly assigned to endoscopic submucosal dissection (ESD) group (n=36)and ESTD group (n=38), and received ESD or ESTD. The time of operation, dissection area and speed, en bloc recetion rate and the radical curative rate were counted, the complications associated with dissection( bleeding, perforation and esophageal stenosis) were observed.

Results

There were no difference in area of lesion of each group .In the lesion size of 1/3-2/3 circumference and more than 2/3 circumference, the operation time of ESTD group were [(50.7 ± 21.3)min, (61.7 ± 29.8)min], which were shorter than those of ESD group[(79.8 ± 19.5)min, (119.8 ± 35.4)min](P<0.05), the dissection speed of ESTD were [(21.1 ± 5.6)mm²/min, (28.8 ± 6.1)mm²/min], which were higher than those of ESD group [(14.5 ± 3.7)mm²/min, (15.2 ± 5.1)mm²/min](P<0.05). In the lesion size of less than 1/3 circumference, there were no difference in operation time , dissection speed, en bloc recetion rate and the radical curative rate. Despite a similar en bloc rate and the radical curative rate between two group in the lesion size of 1/3-2/3 circumference, en bloc rate and the radical curative rate of ESTD group were significantly greater than those of ESD group (P<0.05). Intraoperative bleeding occurred in 5 patients in ESTD group and 6 patients in ESD group. No perforation occurred in ESTD group except for 2 patients in ESD group after surgery. 13 patients of ESTD group and 10 patients of ESD group had postoperative esophageal stenosis.

Conclusions

ESTD was safe and effective for the endoscopic management of superficial esophageal neoplasms. Compared with standard ESD, the advantage of ESTD for large superficial esophageal lesions was a shortened operative time, a higher dissection speed and a higher radical curative rate.

Key words: Endoscopic submucosal dissection, Tunnel endoscopy, Esophageal neoplasms.

Lei Chen, Lu Wang, Sujun Gao, Li Zhang, Haihang Zhu, Wei Lu, Di Chen, Zhen Zhu. Effects of endoscopic submucosal tunnel dissection for esophageal superficial neoplasms[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2016, 09(04): 243-247.

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References 24

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项目		ESTD组(38例)	ESD组(36例)
例数[< 1/3周/(1/3～2/3周)/ > 2/3周]		10/15/13	10/14/12
年龄(岁)		64.2±12.47	58.1±11.36
性别(男性/女性)		25/13	17/19
内镜分型(Ⅱb/Ⅱc/Ⅱa＋Ⅱb/Ⅱa＋Ⅱc)		14/5/10/9	6/11/8/11
病灶长(mm)		?	?
?	< 1/3周	2.7±0.75	2.8±0.61
?	1/3～2/3周	4.1±1.32	3.9±1.71
?	> 2/3周	5.6±1.98	5.4±1.25
术后病理(例数)		?	?
?	非浸润高级别瘤变	26	20
?	鳞状细胞癌(m1/m2/m3/sm1)	4/2/4/2	4/5/5/2

项目		ESTD组(38例)	ESD组(36例)
例数[< 1/3周/(1/3～2/3周)/ > 2/3周]		10/15/13	10/14/12
年龄(岁)		64.2±12.47	58.1±11.36
性别(男性/女性)		25/13	17/19
内镜分型(Ⅱb/Ⅱc/Ⅱa＋Ⅱb/Ⅱa＋Ⅱc)		14/5/10/9	6/11/8/11
病灶长(mm)		?	?
?	< 1/3周	2.7±0.75	2.8±0.61
?	1/3～2/3周	4.1±1.32	3.9±1.71
?	> 2/3周	5.6±1.98	5.4±1.25
术后病理(例数)		?	?
?	非浸润高级别瘤变	26	20
?	鳞状细胞癌(m1/m2/m3/sm1)	4/2/4/2	4/5/5/2

项目		ESTD组(38例)	ESD组(36例)	P值
手术时间(min)		?	?	?
?	<1/3周	40.9±12.7	46.5±11.3	>0.05
?	1/3～2/3周	50.7±21.3	79.8±19.5	<0.05
?	>2/3周	61.7±29.8	119.8±35.4	<0.05
术后标本面积(mm²)		?	?	?
?	<1/3周	438.4±59.9	462.9±87.1	>0.05
?	1/3～2/3周	897.6±213.3	869.4±111.7	>0.05
?	>2/3周	1441.1±401.6	1386.7±317.6	>0.05
剥离速度(mm²/min)		?	?	?
?	<1/3周	14.1±4.6	13.8±4.9	>0.05
?	1/3～2/3周	21.1±5.6	14.5±3.7	<0.0
?	>2/3周	28.8±6.1	15.2±5.1	<0.05
整块切除率(%)		?	?	?
?	<1/3周	10/10	10/10	>0.05
?	1/3～2/3周	15/15	14/14	>0.05
?	>2/3周	13/13	8/12	<0.05
治愈性切除率(%)		?	?	?
?	<1/3周	10/10	10/10	>0.05
?	1/3～2/3周	14/15	12/14	>0.05
?	>2/3周	11/13	5/12	<0.05

项目		ESTD组(38例)	ESD组(36例)	P值
手术时间(min)		?	?	?
?	<1/3周	40.9±12.7	46.5±11.3	>0.05
?	1/3～2/3周	50.7±21.3	79.8±19.5	<0.05
?	>2/3周	61.7±29.8	119.8±35.4	<0.05
术后标本面积(mm²)		?	?	?
?	<1/3周	438.4±59.9	462.9±87.1	>0.05
?	1/3～2/3周	897.6±213.3	869.4±111.7	>0.05
?	>2/3周	1441.1±401.6	1386.7±317.6	>0.05
剥离速度(mm²/min)		?	?	?
?	<1/3周	14.1±4.6	13.8±4.9	>0.05
?	1/3～2/3周	21.1±5.6	14.5±3.7	<0.0
?	>2/3周	28.8±6.1	15.2±5.1	<0.05
整块切除率(%)		?	?	?
?	<1/3周	10/10	10/10	>0.05
?	1/3～2/3周	15/15	14/14	>0.05
?	>2/3周	13/13	8/12	<0.05
治愈性切除率(%)		?	?	?
?	<1/3周	10/10	10/10	>0.05
?	1/3～2/3周	14/15	12/14	>0.05
?	>2/3周	11/13	5/12	<0.05

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