PDF(Pubmed)
Abstract：
Background and study aim: Endoscopic submucosal dissection is a minimally invasive endoscopic procedure for the removal of neoplastic benign and early malignant lesions in the gastrointestinal tract. In this study, we analyse the success and safety of rectal ESD at Linz hospitals, focusing on a specific endoscopist. Additionally, we examine whether there is a learning curve regarding success parameters. Methods: This retrospective study included all 102 patients who underwent endoscopic submucosal dissection of the rectum by a defined endoscopist at Ordensklinikum Hospital and Kepler University Hospital between December 2010 and May 2021. With the collected data, a descriptive statistic was carried out and regression analyses were performed. Results: The en bloc resection rate was 78.4% and the rate of lesions removed in healthy tissue was 55.6%. The average procedure time was 179 min and the complication rate was 7.8%. In total, 26.4% of cases showed carcinoma; in 25.9% of these cases, an oncologically curative resection was achieved with ESD. Follow-up data were available for 61.1% of cases, with recurrence being diagnosed in 3.6% of cases. A learning curve was observed regarding the rate of lesions removed in healthy tissue and the procedure time, but not regarding the en bloc resection rate. Conclusions: Endoscopic submucosal dissection is a safe method for the removal of large rectal adenomas and early carcinomas. The en bloc resection rate of the analysed procedures is within the range of comparable European studies. The rate of lesions removed in healthy tissue is below the R0 resection rate of the comparative literature; however, a learning curve could be observed in this parameter.
摘要：
背景和研究目的：内镜黏膜下剥离术是一种微创内镜手术，用于清除胃肠道中的肿瘤性良性和早期恶性病变。在这项研究中,我们分析了林茨医院直肠ESD的成功和安全性，专注于特定的内窥镜医生。此外,我们检查是否有关于成功参数的学习曲线。方法：这项回顾性研究纳入了2010年12月至2021年5月在Ordensklinikum医院和开普勒大学医院接受内镜内镜下直肠黏膜下剥离术的所有102例患者。有了收集的数据，进行描述性统计并进行回归分析.结果：整块切除率为78.4％，健康组织病灶切除率为55.6％。平均手术时间为179min，并发症发生率为7.8%。总的来说,26.4％的病例显示癌症；在这些病例中的25.9％，ESD实现了肿瘤治愈性切除.61.1%的病例有随访数据,3.6%的病例被诊断为复发。观察健康组织病灶清除率和手术时间的学习曲线，但不是关于整体切除率。结论：内镜黏膜下剥离术是切除大型直肠腺瘤和早期癌的安全方法。所分析的程序的整体切除率在可比的欧洲研究的范围内。健康组织中病灶的切除率低于对比文献的R0切除率；然而，在这个参数中可以观察到学习曲线。
