盐水浸泡内镜下粘膜下剥离治疗早期巴雷特食管腺癌及食管大静脉曲张

Q3 Medicine

VideoGIE Pub Date : 2025-03-01 DOI:10.1016/j.vgie.2025.02.009

Giuliano Francesco Bonura MD , Thomas Veiser MD , Tobias Dertmann MD , Jorg Hollerich MD , Mauro Manno MD , Edward John Despott MD, FRCP, FEBGH, FASGE, MD (Res) , Naohisa Yahagi MD, PhD , Torsten Beyna MD, PhD

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引用次数: 0

摘要

背景和目的我们报告一位65岁的男性患者，他被诊断为一大块早期巴雷特食管腺癌，延伸约10厘米，累及食管周长的三分之二。CT扫描显示中度食管静脉曲张扩张，内镜检查未见；然而，在腹部超声、弹性成像和实验室检查中没有发现肝硬化的迹象。因此，在与肿瘤委员会初步讨论后，我们进行了内镜下粘膜剥离（ESD）。方法采用超薄治疗胃镜（eg - 840tp超薄治疗胃镜，日本东京富士胶片公司）。该胃镜具有7.9毫米的插入管，具有3.2毫米的大工作通道，并通过扩大角度（210°上/160°下）提供动力，显着提高了可操作性。采用最新一代混合刀（HYBRIDknife flex I-Type, Erbe, t bingen, Germany），进一步提高了切割和凝固精度。手术在琥珀红色成像（富士胶片）模式下进行，专门设计用于增强深血管和粘膜下间隙/肌肉的可见性。结果第一次粘膜远缘切口出血明显后，改变初始隧道建立方法的治疗方案，在盐水浸泡技术和双夹线牵引的辅助下进行完整的环周切口粘膜下剥离。重要的是，在ESD过程中，在第三空间遇到明显扩张的食管静脉曲张（直径达7mm）的密集网络，显着延长了手术时间。然而，静脉曲张都得到了预防性的识别和治疗。最后，病灶整体切除，无不良事件发生。患者3天后无症状出院，组织病理学检查显示黏膜内腺癌（pT1a, m2, L0, V0, Bd1, R0, G1）切除可治愈。在3个月的内镜随访中，未观察到明显的狭窄或残留/复发的肿瘤病变。结论Barrett食管腺癌位于食管静脉曲张处，即使以前没有静脉曲张治疗，esd也可以作为一种可行的选择。

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Saline immersion endoscopic submucosal dissection for management of early Barrett’s esophagus adenocarcinoma and large esophageal varices

Background and Aims

We report the case of a 65-year-old man who was referred to our unit with a diagnosis of a large early Barrett’s esophagus adenocarcinoma, extending for about 10 cm and involving two-thirds of the esophageal circumference. CT scan revealed a moderate esophageal variceal ectasia not visible at endoscopic evaluation; however, no sign of liver cirrhosis had been identified at abdominal ultrasound, elastography, and laboratory examinations. Therefore, after a preliminary discussion with the tumor board, we performed endoscopic submucosal dissection (ESD).

Methods

An ultraslim therapeutic endoscope (EG-840 TP Slim Treatment Gastroscope, Fujifilm, Tokyo, Japan) was used. This gastroscope has a 7.9-mm insertion tube endowed with a large 3.2-mm working channel and powered by an expanded angulation (210° up/160° down) that significantly improves maneuverability. Moreover, the latest-generation hybrid-knife (HYBRIDknife flex I-Type, Erbe, Tübingen, Germany) was used, further improving the cut and coagulate precision. The procedure was performed under amber-red-color imaging (Fujifilm) mode, specifically designed to enhance the visibility of deep vessels and submucosal space/muscle.

Results

Following significant bleeding after first mucosal incision at the distal margin, the initial therapeutic plan of tunnel creation method was changed, and a complete circumferential incision was performed followed by a submucosal dissection assisted by the saline-immersion technique and double clip-line traction method. Importantly, during ESD a dense network of marked dilated esophageal varices (up to 7 mm in diameter) were encountered in the third space, significantly prolonging the procedural time. However, varices were all preventively identified and treated. Finally, the lesion was resected en bloc, and no adverse events occurred. The patient was discharged home 3 days later asymptomatic, and histopathological evaluation revealed a curative intramucosal adenocarcinoma (pT1a, m2, L0, V0, Bd1, R0, G1) resection. At 3-month endoscopic follow-up, no significant stricture or residual/recurrence neoplastic lesion were observed.

Conclusions

ESD of Barrett's esophagus adenocarcinoma located at esophageal varices may be considered a viable option even without previous variceal treatment.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.