Endoscopic mucosal resection using a cap-fitted endoscope improves tissue resection and pathology interpretation: An animal study

被引：15

作者：

Farrell J.J. ^{[1
]}

Lauwers G.Y. ^{[2
]}

Brugge W.R. ^{[3
]}

机构：

[1] Divison of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA 90095

[2] Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

[3] Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA

来源：

Gastric Cancer | 2006年 / 9卷 / 1期

关键词：

Cap; Early esophageal cancer; Early gastric cancer; EMR; Endotherapy; Mucosal resection; Snare;

D O I：

10.1007/s10120-005-0349-0

中图分类号：

学科分类号：

摘要：

Background. Endoscopic mucosal resection using a cap-fitted endoscope (EMRC) has been proposed to be significantly better and safer for tissue resection compared with standard snare EMR. However, there are no valid animal or clinical data to support this. We aimed to compare EMRC with standard snare EMR in a porcine model with respect to tissue resected, ease of procedure, and degree of diathermic injury to the resected specimen. Methods. Gastric EMRs were randomly performed in pigs using a variety of techniques, including EMRC (1mm and 17-mm cap) and the standard snare technique, using a single-channel method without a grasping forceps. Geometric and histological assessment of the resection specimen for size, histological depth, and diathermic injury were performed by a single pathologist, blinded to the endoscopic techniques used. Results. Thirty-six gastric mucosal resections were randomly performed in three pigs. Use of EMRC resulted in a statistically significant greater resection specimen by weight, size, and histological depth compared with standard EMR (P < 0.04). Large-cap EMRC resulted in a statistically significant greater resection weight and size compared to small-cap EMRC (P < 0.05). There was a statistically significant greater degree of diathermic injury in the specimens resected using the standard snare EMR technique compared with EMRC (P < 0.006). There were no acute complications with either technique. Conclusion. Gastric EMRC is more technically effective than and as safe and easy as standard snare EMR. Use of the cap, especially the larger cap, is associated with larger and deeper mucosal resection and less diathermic injury compared with the standard snare technique, making the pathologic assessment of depth and margin involvement more reliable. When possible, EMRC should be the EMR method of choice. © 2006 by International and Japanese Gastric Cancer Association.

引用

页码：3 / 8

页数：5

共 21 条

[1]

Makuuchi H., Kise Y., Shimada H., Chino O., Tanaka H., Endoscopic mucosal resection for early gastric cancer, Semin Surg Oncol, 17, pp. 108-16, (1999)

[2]

Ono H., Kondo H., Gotoda T., Shirao K., Yamaguchi H., Saito D., Et al., Endoscopic mucosal resection for treatment of early gastric cancer, Gut, 48, pp. 225-9, (2001)

[3]

Inoue H., Treatment of esophageal and gastric tumors, Endoscopy, 33, pp. 119-25, (2001)

[4]

Soetikno R., Inoue H., Chang K., Endoscopic mucosal resection, Gastrointest Endosc Clin N Am, 10, pp. 595-617, (2000)

[5]

Deyhle P., Largiader F., Jenny S., A method for endoscopic electroresection of sessile colonic polyps, Endoscopy, 5, pp. 38-40, (1973)

[6]

Takemoto T., Yania H., Karita M., Okita K., Significance of strip biopsy with particular reference to endoscopic mucosectomy, Dig Endosc, 1, pp. 4-9, (1989)

[7]

Tada M., Murakami A., Karita M., Yanai H., Okita K., Endoscopic resection of early gastric cancer, Endoscopy, 25, pp. 445-50, (1993)

[8]

Hirao M., Masuda K., Asanuma T., Naka H., Noda K., Matsuura K., Et al., Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine, Gastrointest Endosc, 34, pp. 264-9, (1988)

[9]

Inoue H., Takeshita K., Hori H., Muraoka Y., Yoneshima H., Endo M., Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions, Gastrointest Endosc, 39, pp. 58-62, (1993)

[10]

Takeshita K., Tani M., Inoue H., Saeki I., Honda T., Kando F., Et al., A new method of endoscopic mucosal resection of neoplastic lesions in the stomach: Its technical features and results, Hepatogastroenterology, 44, pp. 1602-11, (1997)

← 1 2 3 →