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AJG:大样本人群研究证实内镜下粘膜切除治疗巴雷特食管安全性佳

2013-10-16 tiancai_erbao dxy

研究热点: 内镜下粘膜切除术治疗巴雷特食管是相对安全的。但就其相关并发症的发生情况在大样本人群中缺乏相关报道。 作者系统性复习了一个前瞻性维护数据库中内镜下粘膜切除治疗巴雷特食管患者的数据,对并发症发生情况进行了分析。 在该项大样本人群研究中,治疗后出现食管狭窄的几率为1%,术后出血发生率为1.2%,无发生穿孔病例。并发症发生率很低。 内镜下粘膜切除术是治疗巴雷特食管的一种方法。虽然内镜下

研究热点:

内镜下粘膜切除术治疗巴雷特食管是相对安全的。但就其相关并发症的发生情况在大样本人群中缺乏相关报道。

作者系统性复习了一个前瞻性维护数据库中内镜下粘膜切除治疗巴雷特食管患者的数据,对并发症发生情况进行了分析。

在该项大样本人群研究中,治疗后出现食管狭窄的几率为1%,术后出血发生率为1.2%,无发生穿孔病例。并发症发生率很低。

内镜下粘膜切除术是治疗巴雷特食管的一种方法。虽然内镜下粘膜切除已经是被普遍接受的安全性较好的治疗方法,但公开发表的数据显示仍然存在内镜下粘膜切除的相关并发症,而且一些关于执行内镜下粘膜切除术的专业技术信息并未公开。美国明尼苏达州罗彻斯特市梅奥诊所消化内科巴瑞特食管单元的Yutaka   Tomizawa等人在其巴雷特食管专业单位中,在大样本人群中评估了患者进行内镜下粘膜切除术的相关并发症发生情况。

系统性复习一个前瞻性维护数据库中从1995年1月至2008年8月这一时间段内所有进行内镜下粘膜切除治疗的巴雷特食管患者的数据。内镜下粘膜切除是在出现肿瘤样病变的患者中进行。出血、狭窄、内镜下粘膜切除相关性穿孔作为主要的结果指标进行了度量。

共计有681名患者(83%为男性,平均年龄70岁)进行了1388次内镜检查及2513次内镜下粘膜切除术治疗。巴雷特食管病变平均长度为3.0cm(四分位范围为1-7)。其中99%的内镜下粘膜切除术全部程序由一位有经验的内镜医师完成。95%的内镜下粘膜切除术是采用商用内镜下粘膜切除包完成(77%为帽圈套器,18%为带圈套器),5%的手术是采用曲张静脉结扎设备完成。

在研究期间内无内镜下粘膜切除术相关穿孔情况发生。切除术后出血的发生率为1.2%(8例)。其中7例经内镜下治疗后成功止血,1例需要手术治疗。内镜下粘膜切除术后明显狭窄症状的发生率为1.0%(7例),但所有的病例均无需进行介入消融治疗,所有病例经内镜下扩张治疗均有效缓解了症状。

该项研究是迄今为止关于内镜下粘膜切除治疗巴雷特食管的最大系列报道。在这项大型回顾性研究中可以看出,由经验丰富的内镜医师对具有手术适应症的巴雷特食管患者进行内镜下粘膜切除术治疗,发生并发症的几率是很低的。

研究背景:

巴雷特食管是胃食管反流病的并发症,表现为肠道柱状上皮取代原有正常的鳞状上皮。巴雷特食管与食管腺癌发生之间的关系已被广泛接受。两项大规模人群临床研究结果提示在巴雷特食管患者中一小部分人会出现肠上皮化生、不典型增生、腺癌的序列演进过程。在美国由巴雷特食管演变为的食管腺癌发生率在上升。被确诊为巴雷特食管的患者通常要进行周期性内镜检查监测,以便能够及时发现不典型增生病变或在癌变的起始阶段进行确诊,此时处于早期的食管腺癌是可以被有效治疗的。

内镜下粘膜切除术是被用来对巴雷特食管出现重度不典型增生或早期食管腺癌进行诊断和治疗的技术。内镜下粘膜切除术是对巴雷特食管病变节段,在内镜下清晰可视的区域发生不典型增生或瘤变的粘膜进行病灶的切除。对切除标本进行组织病理学检测后根据结果指导患者进行进一步的内镜下治疗。内镜下粘膜切除术可以单独或者联合其他仪器治疗(如射频消融)来清除活检后剩余病变(不典型增生或癌变)组织。

内镜下粘膜切除被认为是相对安全的治疗方式,但就其相关并发症的发生率及并发症的种类仍缺乏在大样本人群中的研究。现有的关于内镜下粘膜切除术的并发症的发生率在不同的研究中报道结果差异较大,并受到了样本人群过小的限制。例如不同的研究中内镜下粘膜切除术后出血的发生率的变化范围就在1%到45%之间。而且,在现有的研究中,关于内镜下粘膜切术术术者的专业技术也未公开。
因此鉴于上述研究现状,作者在巴雷特食管专业治疗单元中在大样本人群中报道了采用内镜下粘膜切除术治疗巴雷特食管的相关并发症的发生情况。

原文检索

Tomizawa Y, Iyer PG, Wong Kee Song LM, Buttar NS, Lutzke LS, Wang KK.Safety of Endoscopic Mucosal Resection for Barrett's Esophagus.Am J Gastroenterol. 2013 Sep;108(9):1440-7.

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    2014-09-12 hb2008ye
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    2014-09-17 zhzhxiang
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    2014-06-19 minzju5052
  4. [GetPortalCommentsPageByObjectIdResponse(id=1690938, encodeId=eedc1690938f4, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Sep 12 18:06:00 CST 2014, time=2014-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669322, encodeId=e4aa166932245, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Wed Sep 17 17:06:00 CST 2014, time=2014-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057238, encodeId=5478205e23888, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Thu Jun 19 09:06:00 CST 2014, time=2014-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261833, encodeId=757412618336c, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338363, encodeId=5b6413383630d, content=<a href='/topic/show?id=f3c848321b4' target=_blank style='color:#2F92EE;'>#巴雷特食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48321, encryptionId=f3c848321b4, topicName=巴雷特食管)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/XhttJCp4Aq9gKA5n4v9elclQlVQTDenMiaEiadlI5D3gtmfSiaicoIY4ZsuibrQKLibDdxBKVY8oS6B2FicqJlT93clow/132, createdBy=03202500144, createdName=ms7258648636991762, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437042, encodeId=a868143e04250, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1690938, encodeId=eedc1690938f4, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Sep 12 18:06:00 CST 2014, time=2014-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669322, encodeId=e4aa166932245, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Wed Sep 17 17:06:00 CST 2014, time=2014-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057238, encodeId=5478205e23888, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Thu Jun 19 09:06:00 CST 2014, time=2014-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261833, encodeId=757412618336c, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338363, encodeId=5b6413383630d, content=<a href='/topic/show?id=f3c848321b4' target=_blank style='color:#2F92EE;'>#巴雷特食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48321, encryptionId=f3c848321b4, topicName=巴雷特食管)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/XhttJCp4Aq9gKA5n4v9elclQlVQTDenMiaEiadlI5D3gtmfSiaicoIY4ZsuibrQKLibDdxBKVY8oS6B2FicqJlT93clow/132, createdBy=03202500144, createdName=ms7258648636991762, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437042, encodeId=a868143e04250, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1690938, encodeId=eedc1690938f4, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Sep 12 18:06:00 CST 2014, time=2014-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669322, encodeId=e4aa166932245, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Wed Sep 17 17:06:00 CST 2014, time=2014-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057238, encodeId=5478205e23888, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Thu Jun 19 09:06:00 CST 2014, time=2014-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261833, encodeId=757412618336c, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338363, encodeId=5b6413383630d, content=<a href='/topic/show?id=f3c848321b4' target=_blank style='color:#2F92EE;'>#巴雷特食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48321, encryptionId=f3c848321b4, topicName=巴雷特食管)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/XhttJCp4Aq9gKA5n4v9elclQlVQTDenMiaEiadlI5D3gtmfSiaicoIY4ZsuibrQKLibDdxBKVY8oS6B2FicqJlT93clow/132, createdBy=03202500144, createdName=ms7258648636991762, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437042, encodeId=a868143e04250, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 18 04:06:00 CST 2013, time=2013-10-18, status=1, ipAttribution=)]
    2013-10-18 zhouqu_8
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