کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3307471 1210385 2008 10 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Endoluminal resection for sessile neoplasia in the GI tract is associated with a low recurrence rate and a high 5-year survival rate
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیماری‌های گوارشی
پیش نمایش صفحه اول مقاله
Endoluminal resection for sessile neoplasia in the GI tract is associated with a low recurrence rate and a high 5-year survival rate
چکیده انگلیسی

BackgroundEndoluminal resection (ELR) is an alternative to surgery for the removal of superficial neoplastic lesions of the GI tract. We previously reported a complete resection (CR) rate of 89% when using ELR techniques. However, the long-term efficacy of ELR for the eradication of sessile lesions, as well as patient survival after ELR, is not known.ObjectivesTo assess the long-term recurrence rate of GI lesions that were completely resected by ELR and to determine the long-term (5-year) survival rate of patients who had ELR for GI lesions that contained high-grade dysplasia (HGD) or adenocarcinoma (AdCa).DesignFrom a larger cohort of 92 consecutive patients who had undergone ELR of sessile lesions from 1997 to 2000, long-term follow-up was obtained. Patient survival rates were considered in terms of disease-specific mortality.ResultsEndoscopic follow-up was possible in 44 patients (48%) and 46 lesions (46%). At the time of the initial ELR, the median age was 68.5 years. The median duration of follow-up was 3.8 years after ELR (range 7 months to 8.1 years). Resected lesions were located in the esophagus (25%), stomach (11%), duodenum (25%), colon (27%), and rectum (11%). Post-ELR histopathology consisted of adenomas (46%), HGD (16%), AdCa (11%), lymphoma (2%), leiomyoma (2%), carcinoid (2%), lesions indeterminate for dysplasia (2%), and nondysplastic lesions (18%). CR was achieved in 42 patients and 44 lesions (96%) after initial ELR procedures (range 1-3). Thirty-seven of 39 neoplastic lesions (95%) in this cohort achieved initial CR. Two lesions (found in 2 patients) that did not achieve initial CR were excluded from analysis. Four of 37 neoplastic lesions (10.8%) that underwent successful ELR had local recurrence of neoplasia (median time to recurrence was 1.9 years). Two of the 4 neoplastic recurrences were successfully eradicated by subsequent endoscopic techniques (95% overall eradication rate). Long-term endoscopic follow-up was possible in 12 of 20 patients (60%) with HGD or AdCa who achieved initial CR. These 12 patients had HGD (n = 7) or AdCa (n = 5) and were observed for an average of 4.9 years (range 1.4-7.9 years) after an ELR. Two of these patients died during follow-up, but only 1 death (8%) was lesion related. When comparing post-ELR pathology, HGD and AdCa trended toward an increased risk of recurrence compared with other neoplastic lesions (hazard ratio 4.75 [95% CI, 0.49-46.35], P = .18).LimitationsA retrospective study with 52% of patients lost to long-term endoscopic follow-up, which limited the sample size and the number of events.ConclusionsELR effectively eradicates sessile neoplastic lesions from the GI tract, with a low recurrence rate (10.8%) at long-term follow-up. Post-ELR surveillance is important, because local recurrences may be amenable to endoscopic eradication. HGD and cancers may carry an increased risk for a local recurrence, with a 5-year disease-specific survival of 92%. This study suggests that ELR is associated with a low recurrence rate for neoplastic lesions and appreciable long-term survival in patients with highly dysplastic lesions. Additional, long-term follow-up studies are necessary to investigate the role of ELR in the treatment of highly dysplastic lesions of the GI tract.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Gastrointestinal Endoscopy - Volume 68, Issue 1, July 2008, Pages 160–169
نویسندگان
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