BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been...BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.展开更多
Endoscopic submucosal dissection(ESD)is a wellestablished treatment for superficial esophageal squamous cell neoplasms(SESCNs)with no risk of lymphatic metastasis.However,for large SESCNs,especially when exceeding two...Endoscopic submucosal dissection(ESD)is a wellestablished treatment for superficial esophageal squamous cell neoplasms(SESCNs)with no risk of lymphatic metastasis.However,for large SESCNs,especially when exceeding two-thirds of the esophageal circumference,conventional ESD is time-consuming and has an increased risk of adverse events.Based on the submucosal tunnel conception,endoscopic submucosal tunnel dissection(ESTD)was first introduced by us to remove large SESCNs,with excellent results.Studies from different centers also reported favorable results.Compared with conventional ESD,ESTD has a more rapid dissection speed and R0 resection rate.Currently in China,ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique,as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria.However,not all patients with SESCNs are candidates for ESTD,and postoperative esophageal strictures should also be taken into consideration,especially for lesions with a circumference greater than three-quarters.In this article,we describe our experience,review the literature of ESTD,and provide detailed information on indications,standard procedures,outcomes,and complications of ESTD.展开更多
With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscular...With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).展开更多
目的,探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。方法,徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例,采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submuc...目的,探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。方法,徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例,采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)法及经食管黏膜下隧道法切除病变,对比及随访观察治疗效果。结果,隧道组均于术中一次性完整剥离切除,一次性整块切除率均为100%,经典ESD组1例圈套器辅助分片切除,一次性整块切除率均为88.9%,术后病理结果提示所有切除标本的侧切缘和基底切缘无肿瘤累及。病变切除的平均直径隧道组为(7.5±3.2)cm,经典ESD组为(8.3±1.4)cm,2组在病变切除面积差异无统计学意义( P >0.05);平均手术时间隧道组为(50.4±28.0)min,经典ESD组为手术时间(82.5±29.7)min,2组在一次性整块切除率、平均手术时间方面,差异有统计学意义( P <0.05)。隧道技术组术中无1例皮下气肿;剥离过程无环形肌受伤害;经典ESD组术中出现纵隔、皮下气肿2例,其中小穿孔的1例应用钛夹缝合,术后3 d气肿均自行消失,术后24 h内出现发热1例,伴有白细胞升高,抗炎对症处理后第2天完全缓解,差异有统计学意义( P <0.05)。结论,内镜经食管黏膜下隧道技术是大面积食管黏膜病变切除安全有效的方法,能有效降低内镜下病变切除的难度,缩短手术时间,减少并发症发生。展开更多
文摘BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.
基金Supported by National Natural Science Foundation of China,No.81370584Military Major Projects of Clinical High-Tech Techniques,No.431EG63G
文摘Endoscopic submucosal dissection(ESD)is a wellestablished treatment for superficial esophageal squamous cell neoplasms(SESCNs)with no risk of lymphatic metastasis.However,for large SESCNs,especially when exceeding two-thirds of the esophageal circumference,conventional ESD is time-consuming and has an increased risk of adverse events.Based on the submucosal tunnel conception,endoscopic submucosal tunnel dissection(ESTD)was first introduced by us to remove large SESCNs,with excellent results.Studies from different centers also reported favorable results.Compared with conventional ESD,ESTD has a more rapid dissection speed and R0 resection rate.Currently in China,ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique,as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria.However,not all patients with SESCNs are candidates for ESTD,and postoperative esophageal strictures should also be taken into consideration,especially for lesions with a circumference greater than three-quarters.In this article,we describe our experience,review the literature of ESTD,and provide detailed information on indications,standard procedures,outcomes,and complications of ESTD.
基金Supported by National Key R and D Program of China,No.2016YFC1303601
文摘With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).
文摘目的,探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。方法,徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例,采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)法及经食管黏膜下隧道法切除病变,对比及随访观察治疗效果。结果,隧道组均于术中一次性完整剥离切除,一次性整块切除率均为100%,经典ESD组1例圈套器辅助分片切除,一次性整块切除率均为88.9%,术后病理结果提示所有切除标本的侧切缘和基底切缘无肿瘤累及。病变切除的平均直径隧道组为(7.5±3.2)cm,经典ESD组为(8.3±1.4)cm,2组在病变切除面积差异无统计学意义( P >0.05);平均手术时间隧道组为(50.4±28.0)min,经典ESD组为手术时间(82.5±29.7)min,2组在一次性整块切除率、平均手术时间方面,差异有统计学意义( P <0.05)。隧道技术组术中无1例皮下气肿;剥离过程无环形肌受伤害;经典ESD组术中出现纵隔、皮下气肿2例,其中小穿孔的1例应用钛夹缝合,术后3 d气肿均自行消失,术后24 h内出现发热1例,伴有白细胞升高,抗炎对症处理后第2天完全缓解,差异有统计学意义( P <0.05)。结论,内镜经食管黏膜下隧道技术是大面积食管黏膜病变切除安全有效的方法,能有效降低内镜下病变切除的难度,缩短手术时间,减少并发症发生。
