Summarizing The Practice Of Endoscopic Submucosal Dissection For Gastric Mucosal Lesion

Objective: The key issue of gastric cancer treatment is to detecting in its very early stages. ESD(endoscopic submucosal dissection)has such merits as minimal invasion and rapid recuperation. This essay is to evaluate the treatment, efficacy and safety of ESD.Methods:: Clinical data of 31 cases in gastric mucosal lesion are retrospectively analyzed, which were treated by the ESD therapy between January 2013 and October 2014 in the Second Affiliated Hospital of Dalian Medical University. This essay is to collect the essential information(including the gender, age, complaints, anticoagulant therapies), the fundamental feature of lesions(including the lesion location and size, the pathological results before the ESD therapy, the operation(including the hemorrhage and perforation in the operation, complications and related methods, the operation duration), and the conditions after surgery(including pathological findings of speciments after surgery, complications after surgery and related methods, the postoperative follow-up). The discussion consists of the en-bloc resection rate of lesions, the curative resection rate of histology, the haemorrhage in and after opertation, the perforation rate, the local recurrence of lesions and the residual rate, postoperative rehabilitation condition). Meanwhile, it compares with 15 cases of early gastric cancer, which were treated by laparoscopic radical resection of gastric cancer in our hospital. After the full information is collected, statistical analysis is analyzed with the SPSS17.0 software. It explores and compares between ESD group and the control group, which refers to operation duration, the length of hospital stay after surgery, postoperative complications and other information.Results: 1. The pathological type of gastric mucosa lesion resection:among 31 patients under ESD treatment,24 patients were diagnosed as mucosal lesions before surgery. There are 5 cases of low grade intraepithelial neoplasia, 2 cases of high grade intraepithelial neoplasia, one case of adenocarcinoma, 7 cases of tubular adenoma, 3 probable cases of early gastric cancer, 2 cases of polyp, one case of interstitialoma, one case of leiomyoma, one case of intraepithelial neoplasia, one probable case of non Hodgkin indolent lymphoma. After postoperative histopathology examination,there are 6 cases of early gastric cancer, 6 cases of moderate or severe dysplasia, 5 cases of gastric stromal tumor, 9 cases of adenoma of stomach, 2 cases of gastric polyp, one case of inflammation, one case of mucosa- associated extranodal marginal zone B cell lymphoma, one case of gastric neuroendocrine tumor, one case of leiomyoma of stomach.2. The completely cure rate of patients under ESD treatment is 100%(31/31). The cure rate of complete tissues reaches as high as 96.7%(30/31). The resection rate of non-curative treatment is 3.3%(1/31). According to the study of this group, there is one case of positive vascular invasion in histopathology examination. Involving surgical operation, there is no carcinoma postoperative histopathology examination.30 cases are of R0 resection, one case is of R1 resection and no Rx resection exists.3. Complication:among all of 31 cases, there are 6 cases of complications. Among them, 3 cases are of intraoperative bleeding and one case is of postoperative bleeding. The rate of intraoperative bleeding is 9.6%(3/31) and the postoperative bleeding is 3.2%(1/31). All the cases improve by hemostasis under endoscope and no cases are transferred to surgery. There are 2 cases of intraoperative perforation. The rate of perforation is 6.4%. Titanium clipping is confirmed under the endoscope and no delayed perforation is observed. Till now, there is no case of digestive tract stenosis, aspiration pneumonia, aeroembolism and deep vein thrombosis.4. Follow-up:under the treatment of ESD, there are 30 patients take regular follow-up among 31 gastric diseases patients; the rate of follow-up is 96.7%(30/31). The duration of follow-up is between one month and 20 months.One gastric cancer patient is diagnosed as a result of loss of treatment udner endoscope. Instead, surgical operation is adopted. Postoperative pathology reports as poorly differentiated adenocarcinoma, no distant metastasis and lymphatic metastasis. One patient experiences ESD treatment twice and postoperative pathology reports as severe dysplasia. Currently, there is no case of local recurrence, residues, distant metastasis and deaths.5. Compared with laparoscopic : examing 15 early gastric cancer patients under laparoscopic radical resection of gastric cancer, the average operetion duration is about 238.4±66.25 min, the average length of postoperatively hospital stay is around 17.2±15.42 days. 2 cases of anastomotic fistula are found after the operations and one patient is complicated with anastomotic fistula and incomplete intestinal obstruction. These three patients received supportive treatment under positive nutrition, anti-infective therapy, gastrointestinal decompression and prohibits of food and water. Consequently, they recover well and need no laparotomy. Compared with control group, the duration of operation is 83.87±55.493 min and postoperatively hospital stay in ESD group is 4.39±0.919 days, which are much lower. What is more, the rate of postoperative complication is much lower about 19.3%.Conclusion: The treatment of ESD has the advantage of disposable and complete lesion excision; it has merits of few complication, little trauma, low cost, short hospital stay, multiple lesions excision in one surgery. All in all, ESD is a method of safe and effective treatment for gastric mucosal and submucosal lesions.