Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett's high-grade dysplasia and early gastric cancer
| Autor: | Jesús Espinel, Eugenia Pinedo, Gabriela Rascarachi |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Dysplasia medicine.medical_specialty Endoscope medicine.medical_treatment Endoscopic mucosal resection Lesion Barrett's esophagus Barrett Esophagus Stomach Neoplasms Gastroscopy medicine Humans Multiband ligator Prospective Studies Prospective cohort study Ligation Aged Aged 80 and over Eary gastric cancer business.industry Gastroenterology General Medicine Middle Aged medicine.disease Polypectomy Surgery Early Gastric Cancer Gastric Mucosa Female medicine.symptom business |
| Zdroj: | Revista Española de Enfermedades Digestivas v.101 n.6 2009 SciELO España. Revistas Científicas Españolas de Ciencias de la Salud instname |
| ISSN: | 1130-0108 |
| Popis: | Aim: due to surgery's high mortality and morbidity, local therapeutic techniques are required for Barrett's high-grade dysplasia (BHGD) and early gastric cancer (EGC). Various techniques are available for endoscopic mucosal resection (EMR) in the GI tract. The "suck and cut" technique, which uses a transparent cap or modified multiband variceal ligator, is usually the most practiced method. A multiband ligator (ML) allows sequential resection without the need for submucosal injection and endoscope withdrawal. The objective of this study was to evaluate the efficacy and safety of EMR with a ML device in the treatment of Barrett's high-grade dysplasia and early gastric cancer. Patients and methods: prospective study. Eight consecutive patients (4 men; median age, 62 years; range 38-89 years) with BHGD (4) or EGC (4) were treated. EMR was performed with a multiband ligator in order to create a pseudopolyp and then permit snare polypectomy of flat mucosal lesions. The pseudopolyp was resected by using pure coagulating current. No submucosal saline injection was administered before resection. Results: a total of 8 consecutive patients were treated with the multiband ligator (ML) technique. Barrett's esophagus (BE): one patient with long BE received 3 EMR sessions. Three patients presented with short BE and received 1 EMR session each. The histology of the EMR specimens confirmed a moderately differentiated adenocarcinoma with submucosal infiltration (1 patient) and BHGD (3 patients). Early gastric cancer (EGC): 3 patients had EGC (type IIa) and 1 patient had high-grade dysplasia. EMR was accomplished in 1 session for each patient. The histology of EMR specimens confirmed a mucinous adenocarcinoma with submucosal infiltration (1 patient), EGC (2 patients), and HGD (1 patient). Complications (mild esophageal stenosis, minor bleeding) occurred in 2 patients. Conclusions: EMR has diagnostic and therapeutic implications, and represents a superior diagnostic modality as compared to traditional biopsy. By means of EMR the resected mucosa is pathologically examined, and the lesion may be appropriately treated. EMR-ML is a safe and effective technique for the treatment of superficial lesions of the digestive tract, and is accepted as an alternative to surgical therapy for non-invasive lesions. Long-term follow-up is needed to determine the clinical impact of this method. |
| Databáze: | OpenAIRE |
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