内镜黏膜下剥离术:食管早癌主要的内镜下治疗方式之一

Endoscopic Submucosal Dissection: One of the Main Endoscopic Treatments for Early Esophageal Cancer

大量研究证明,内镜黏膜下剥离术(Endoscopic submucosal dissection, ESD)已经取代手术成为食管早癌的一线治疗方法。甚至相比于与其他的内镜下治疗方式,ESD具有更明显的优势,因为它能够对食管病变部位进行整体切除和精确的组织病理学评估。对符合ESD治疗适应症的食管早癌,术前需要准确评估食道病变部位的浸润深度,是否存在远处淋巴转移。白光内镜、色素放大内镜、EUS作为可选择的检测手段,为临床医师制定下一步诊疗计划提供可靠依据。同时ESD手术相关不良事件不可忽略,如术中出血、术中穿孔及持续性食管狭窄,ESD技术的持续改进和创新将克服目前ESD的一些局限性,使食管早癌的根治性切除成为积极手术的替代方案。

A large number of studies have demonstrated that Endoscopic submucosal dissection (ESD) has re-placed surgery as the first-line treatment for esophageal early cancer. Even compared to other en-doscopic treatments, ESD has a distinct advantage because it enables total resection of the esopha-geal lesion and accurate histopathological evaluation. Preoperative assessment of the depth of infil-tration and the presence of distant lymphatic metastasis of esophagus lesions is required for early esophageal cancer that meets ESD treatment indications. White light endoscopy, pigment amplifi-cation endoscopy and EUS as alternative detection means provide a reliable basis for clinicians to make the next diagnosis and treatment plan. At the same time, the adverse events related to ESD surgery cannot be ignored, such as intraoperative bleeding, intraoperative perforation and persis-tent esophageal stenosis. Continuous improvement and innovation of ESD technology will overcome some limitations of ESD at present, and make radical resection of esophageal early cancer become an alternative to active surgery.