表在食道扁平上皮腫瘍に対する内視鏡的粘膜下層剥離術の治療成績：北米多施設共同経験
Rishi Subrahmanyan1, Hiroyuki Aihara2, Anand Kumar3
1Johns Hopkins Hospital. Division of Gastroenterology and Hepatology. Baltimore, USA.
Background And Aims:
Endoscopic submucosal dissection (ESD) is recommended as the standard of care for treating superficial esophageal squamous neoplasms (ESN). However, the data in the Western world is limited. This study aims to describe the outcomes of ESD for ESN in North America.
Methods:
We conducted a multi-center retrospective analysis of patients who underwent ESD for superficial ESN at 13 North American academic centers. The primary outcomes were the rates of en bloc, R0, and curative resection. Patient demographics, technical outcomes, clinical outcomes, and adverse events were also reported.
Results:
A total of 150 patients (39% female, mean age 70±10 years) underwent ESD to treat superficial ESN with an average tumor size of 36.6±27.0 mm. En-bloc resection rates for all, LGD/HGD, M1/M2, and M3/SM1 lesions were 97%, 97%, 100%, and 94%, respectively. R0 resection rates for all, LGD/HGD, M1/M2, and M3/SM1 lesions were 73%, 84%, 89%, and 70%, respectively. Curative resection rates for all, LGD/HGD, M1/M2, and M3/SM1 lesions were 55%, 84%, 86%, and 61%, respectively. Adverse events were observed in 25 patients (16.6%). The median follow-up time was 15.7 months (IQR 6.1-28.0). Local recurrence occurred in 12 (8.0%) cases, 3 (2%) cases from curative resection and 9 (6%) cases in non-curative resection (p = 0.04). Metastasis occurred in 8 (5.3%) of all included cases and was only evident in non-curative resections. During this period, 21 (14.0%) patients died of non-ESCC-related causes, and 7 (4.7%) patients died from ESCC.
Conclusion:
ESD is a safe and effective treatment for superficial ESN with a low recurrence rate in lesions that meet the standard criteria for curative resection.
