Subscribe to RSS
DOI: 10.1055/s-0033-1356065
Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei prämalignen und malignen gastrointestinalen Neoplasien
Single Centre Experience of Endoscopic Submucosal Dissection (ESD) in Premalignant and Malignant Gastrointestinal NeoplasiaPublication History
10 May 2013
21 October 2013
Publication Date:
13 February 2014 (online)
![](https://www.thieme-connect.de/media/zfg/201402/lookinside/thumbnails/10.1055-s-0033-1356065-1.jpg)
Zusammenfassung
Einleitung: Die endoskopische Submukosa-Dissektion (ESD) früher gastrointestinaler Neoplasien findet weltweit zunehmende Akzeptanz. In Deutschland ist die ESD auf größere Zentren begrenzt und die Datenlage spärlich. Ziel der vorliegenden Studie ist die Darstellung der Ergebnisse von 46 ESDs eines deutschen Endoskopiezentrums.
Material und Methodik: Zwischen Juni 2007 und Mai 2012 wurden 46 ESDs bei 45 Patienten (33 Männer, 12 Frauen, mittleres Alter: 66,1 Jahre) im Ösophagus (n = 17), Magen (n = 23) und Rektum (n = 6) durchgeführt. Es wurde die technische Erfolgsrate, die Rate der En-bloc-, der R0- und der R0-en-bloc-Resektionen, die Komplikationsrate, die Rate kurativer endoskopischer ESDs sowie die lokale Rezidivrate im Follow-up ermittelt. Die Daten wurden zur Beurteilung eines Lernerfolgs innerhalb zweier Zeitintervalle (Juni 2007 bis Nov. 2010 and Dez. 2010 bis Mai 2012) ausgewertet.
Ergebnisse: Die technische Erfolgsrate der ESD lag bei 93,5 %. Die En-bloc-R0-, R0-en-bloc- und die kurative Resektionsrate lag bei 90,7 %, 74,4 %, 67,4 % bzw. 65,1 %. Die Komplikationsrate lag bei 13 %. Im Verlauf konnte die Rate der En-bloc- und der R0-en-bloc-Resektionen von 81 % auf 100 % bzw. von 52,4 % auf 81,8 % gesteigert werden. Die overall Lokalrezidivrate im Follow-up (median 11,4 Monate) betrug 10 %. Nach einer kurativen R0-en-bloc-Resektion von Malignomen traten keine Lokalrezidive auf.
Diskussion: Die vorliegenden Daten unterstreichen trotz der kleinen Fallzahl die Wertigkeit der ESD, insbesondere bei R0-en-bloc-Resektionen in der Therapie prämaligner und früher maligner gastrointestinaler Neoplasien. Aufgrund der notwendigen Lernkurve sollte die Durchführung einer ESD in Deutschland größeren endoskopischen Zentren vorbehalten bleiben.
Abstract
Introduction: Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre.
Material and Methods: Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012).
Results: ESD was technically possible in 93.5 %. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7 %, 74.4 %, 67.4 % and 65.1 %, respectively. The complication rate was 13 %. In the second period en-bloc and R0 en-bloc resection rates increased from 81 % to 100 % and, respectively, from 52.4 % to 81.8 %. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10 %. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred.
Discussion: Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany.
-
Literatur
- 1 Rembacken BJ, Gotoda T, Fujii T et al. Endoscopic mucosal resection. Endoscopy 2001; 33: 709-718
- 2 Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005; 23: 4490-4498
- 3 Rabenstein T, Ell C, Feussner H. Endoskopische Resektion und minimal-invasive Verfahren beim Magenkarzinom. Der Onkologe 2008; 14: 350-361
- 4 Wang KK, Prasad G, Tian J. Endoscopic mucosal resection and endoscopic submucosal dissection in esophageal and gastric cancers. Curr Opin Gastroenterol 2010; 26: 453-458
- 5 Probst A, Golger D, Arnholdt H et al. Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin Gastroenterol Hepatol 2009; 7: 149-155
- 6 Miyamoto S, Muto M, Hamamoto Y et al. A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 2002; 55: 576-581
- 7 Yamamoto H, Kawata H, Sunada K et al. Successful en-bloc-resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small caliber-tip-transparent hood. Endoscopy 2003; 35: 690-694
- 8 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma – second English edition. Gastric Cancer 1998; 1: 10-24
- 9 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric cancer 2000; 3: 219-225
- 10 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
- 11 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
- 12 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 2010; 42: 1037-1044
- 13 Cao Y, Liao C, Tan A et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
- 14 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections. Gastrointest Endosc 2010; 72: 1217-1225
- 15 Saito Y, Fukuzawa M, Matsuda T et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
- 16 Lian J, Chen S, Zhang Y et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
- 17 Forman D, Burley VJ. Gastric cancer: global pattern of the disease and an overview of environmental risk factors. Best Pract Res Clin Gastroenterol 2006; 20: 633-649
- 18 Choi IJ, Kim CG, Chang HJ et al. The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 2005; 62: 860-865
- 19 Hotta K, Oyama T, Shinohara T et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 2010; 22: 302-306
- 20 Farhat S, Chaussade S, Ponchon T et al. SFED ESD study group Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 2001; 43: 664-670
- 21 Oda I, Saito D, Tada M et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
- 22 Fujishiro M, Kodashima S. Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus 2009; 6: 143-148
- 23 Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc 2012; 4: 162-166
- 24 Okada K, Fujisaki J, Yoshida T et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 2012; 44: 122-127
- 25 Toyonaga T, Man-i M, East JE et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
- 26 Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007; 10: 1-1
- 27 Ono S, Fujishiro M, Niimi K et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
- 28 Hulagu S, Senturk O, Aygun C et al. Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers. World J Gastroenterol 2011; 17: 1701-1709