A gyomor endoszkópos mucosaresectiója - Diagnosztikus és terápiás módszer

Tibor Szalóki, Veronika Tóth, László Tiszlavicz, László Czakó

Research output: Article

3 Citations (Scopus)

Abstract

Background: EMR is a widely used treatment option for gastric adenoma and early gastric cancer, but, there are no data on its use in Hungary. The aim of this study was to assess the diagnostic and therapeutic efficacy of EMR. Patients: 44 patients (30 females, 14 males, mean age: 67 years) were studied between 1994 and 2005; 33 had severe concomitant diseases (liver cirrhosis or severe cardiovascular disease). Indigo carmine dye staining and electronic magnification was used in all cases, with endoscopic ultrasonography when indicated. 56 EMRs were performed. The histological results on the biopsy and resected specimens were analyzed. Results: The morphology of the lesions was type I in 20, type IIa in 35, and type IIa-IIc in 1 case. The diagnosis at first biopsy was in situ carcinoma in 3, adenoma with no dysplasia in 19, adenoma with low-grade dysplasia in 2, adenoma with moderate-grade dysplasia in 6, adenoma with high-grade dysplasia in 7, and hyperplastic lesion in 17 cases. The histology of EMR revealed in situ carcinoma in 5, carcinoid in 1, gastro-intestinal stromal tumor in 1, adenoma with no dysplasia in 14, adenoma with low-grade dysplasia in 3, adenoma with moderate-grade dysplasia in 9, adenoma with high-grade dysplasia in 1, hyperplastic lesion in 21, and no diagnosis in 1 case. However, the moderate- and high-grade dysplasia was diagnosed in different cases with the two methods. EMR was considered complete in all but 1 case. A Nd YAG laser was used in this patient with in situ carcinoma, where the resection margin was not free of cancer cells. Bleeding occurred in 3 cases; 1 required transfusion and had pneumonia postoperatively. There were no gastric cancer-related deaths during the median follow-up of 33 (1-90) months. In the follow up period we could not observe gastric malignancy in the previously hyperplastic polyp cases. Among adenoma cases one recurrence was seen in the same place and one in another location. One hyperplastic residuum occurred and in one case adenoma has grown in the same place. Conclusion: EMR, a facile and useful diagnostic and therapeutic technique, appears very safe in terms of complications even in patients with comorbidities. Biopsy is generally unreliable to diagnose gastric adenoma. Lesions should be fully resected by EMR for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment.

Translated title of the contributionDiagnostic and therapeutic use of endoscopic mucosal resection (EMR)
Original languageHungarian
Pages (from-to)501-507
Number of pages7
JournalOrvosi hetilap
Volume147
Issue number11
Publication statusPublished - márc. 19 2006

Keywords

  • Early gastric cancer
  • Endoscopic mucosal resection
  • Gastric adenoma
  • Hyperplastic polyp
  • Indigo carmine dye staining

ASJC Scopus subject areas

  • Medicine(all)

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