内镜下粘膜切割和JNET对结直肠瘤的分类:一个北美学术中心的经验
Nabeel Ahmed1, Robert Bechara2
1Faculty of Medicine and Health Sciences McGill University Montreal Canada.
DEN open
|November 29, 2023
概括
内镜下粘膜切割 (ESD) 可以安全切除结直肠瘤. 日本窄带成像专家团队 (JNET) 的分类准确地预测了组织学,在北美超越了ESD前活检.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 在瘤学瘤学.
背景情况:
- 内镜下粘膜剖析 (ESD) 是一种微创的技术,用于切除表面胃肠道瘤.
- 日本窄带成像专家团队 (JNET) 的分类有助于使用光学放大和窄带成像 (NBI) 预测病变组织学.
- 北美地区的ESD采用和结果,以及JNET分类在该地区的实用性,并未得到充分记录.
研究的目的:
- 评估JNET分类在北美结直肠病变ESD程序中的应用和诊断产量.
- 评估ESD对表面结直肠瘤的安全性和有效性.
- 为了比较JNET分类的准确性与ESD前活检进行组织学预测.
主要方法:
- 从2016年7月至2023年2月期间,对112名因结直肠病变而接受ESD的患者进行了前性维护数据的回顾性分析.
- 病变按位置分层,JNET,NBI国际结直肠内镜,横向扩散的瘤和巴黎分类.
- 在临床病理学数据上进行了单变量分析,p < 0.05被认为是显著的.
主要成果:
- 在96.4%的病例 (107/111) 中成功完成了ESD,其中98.1% (105/107) 进行了整体切除,87.9% (94/107) 实现了R0切除.
- 副作用的发生率很低 (1.8%, 2/111). 病变的中位直径为4.0厘米,在62.0分钟内切除.
- 在JNET 2B中,高度生殖不良或sm1的准确率为80.2%,所有JNET类型3的病变都是sm2或更深的 (p < 0.001).
- 在ESD前活检的组织学上升阶段发生在70.1% (47/67) 的病变中.
结论:
- 在北美环境中,ESD是一种安全有效的切除表面结直肠瘤的方法.
- 在预测病变组织学方面,JNET分类比切割前活检更准确.
- 这些发现支持JNET分类在指导结直肠病变的ESD治疗决策方面的有用性.
相关概念视频
01:25Endoscopic Procedures II: Colonoscopy
The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
01:28Endoscopic Procedures III: Video Capsule Endoscopy
Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers, unexplained...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...