设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

学习实施食管肿瘤内镜切除与显著并发症息息有关,即便在一项结构化的培训计划中也是相关的

发布日期:2014-1-29 12:40:32 文章来源:Endoscopy 作者次数:1180
    学习实施食管肿瘤内镜切除与显著并发症息息有关,即便在一项结构化的培训计划中也是相关的

    F. G. I. van Vilsteren1, R. E. Pouw1, L. A. Herrero2, F. P. Peters1, R. Bisschops3, M. Houben4, F. T. M. Peters5, B. E. Schenk6, B. L. A. M. Weusten2, M. Visser7, F. J. W. Ten Kate7, P. Fockens1, E. J. Schoon8, J. J. G. H. M. Bergman1

    1荷兰阿姆斯特丹学术医学中心胃肠病科

    2荷兰新维根圣安医院胃肠病科

    3荷兰鲁汶大学附属盖斯堡医学中心胃肠病科

    4荷兰海牙Haga教学医院胃肠病科

    5荷兰格罗宁根大学医学中心胃肠病科

    6荷兰兹沃勒Isala诊所胃肠病

    7荷兰阿姆斯特丹学术医学中心病理科

    8荷兰埃因霍温Catharina医院胃肠病科

    背景和研究目的:内镜切除是内镜治疗食管高度异型增生或早期癌的基石。然而内镜切除是一种技术要求比较高的手术,它需要操作者经过培训,并且具有专业知识。该研究目的是前瞻性评估由六位正参与内镜切除培训计划的内镜师对早期食管瘤实施的前120例内镜切除术的有效性和安全性,其中每位内镜师行20例内镜切除术。

    患者和方法:该项目由4个课程组成,每课程每三个月一天,并包含讲座,现场示范,对已麻醉猪的实际训练,以及一对一的实际培训。参加者有来自各中心的具有上消化道肿瘤学多学科专业知识的胃肠病医生,还有内镜检查护士和一位病理学家。结果测量指标为目标区域的完全内镜切除与急性并发症。

    结果:六位内镜医师共实施了120例食管内镜切除术(85带帽内镜切除术,35例多环黏膜切除术):109例为治疗Barrett食管,11例为治疗鳞状上皮瘤;85例内镜下分片切除术(中位数为3个标本,四分位间距为2-4个标本)。120个病例中,111例(92.5%)实现完全内镜下切除。6例(5.0%)发生穿孔:内镜下有效治疗的有5例(夹子,覆膜支架),1例接受食管切除术。11例发生急性轻度出血(9.2%),而且它们是在内镜下被治疗。由4位参与者实施的带帽内镜切除术中发生穿孔(7.1%带帽内镜切除术与0%多环黏膜切除术;P= 0.18),而且每位内镜医师的前10例内镜切除术与随后的10例内镜切除术发生穿孔概率分别为1.7%8.3%P= 0.26)。

    结论:在这个非常的结构化的培训计划中,由6位参与者实施的前120例内镜下食管切除术中发生穿孔的概率为5.0%。尽管穿孔得到了充分治疗,但行20例内镜切除可能不足以达到内镜切除经验曲线的峰值。

     

     

    ------------------------------------------------------------------------------

     

    Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program

    F. G. I. van Vilsteren1, R. E. Pouw1, L. A. Herrero2, F. P. Peters1, R. Bisschops3, M. Houben4, F. T. M. Peters5, B. E. Schenk6, B. L. A. M. Weusten2, M. Visser7, F. J. W. Ten Kate7, P. Fockens1, E. J. Schoon8, J. J. G. H. M. Bergman1

    1Gastroenterology, AcademicMedicalCenter,Amsterdam, TheNetherlands

    2Gastroenterology, St Antonius hospital, Nieuwegein, The Netherlands

    3Gastroenterology, University MedicalCenterGasthuisberg Leuven, TheNetherlands

    4Gastroenterology, Haga Teaching Hospital Den Haag, TheNetherlands

    5Gastroenterology,UniversityMedicalCenterGroningen, TheNetherlands

    6Gastroenterology, Isala ClinicsZwolle, TheNetherlands

    7Pathology,AcademicMedicalCenter,Amsterdam, TheNetherlands

    8Gastroenterology,CatharinaHospitalEindhoven, TheNetherlands

    Background and study aims: Endoscopic resection is the cornerstone of endoscopic treatment of esophageal high grade dysplasia or early cancer. Endoscopic resection is, however, a technically demanding procedure, which requires training and expertise. The aim of the current study was to prospectively evaluate efficacy and safety of the first 120 endoscopic resection procedures of early esophageal neoplasia performed by six endoscopists (20 endoscopic resections each) who were participating in an endoscopic resection training program.

    Patients and methods: The program consisted of four tri-monthly 1-day courses with lectures, live-demonstrations, hands-on training on anesthetized pigs, and one-on-one hands-on training days. Gastroenterologists from centers with multidisciplinary expertise in upper gastrointestinal oncology participated, together with an endoscopy nurse and a pathologist. Outcome measures were complete endoscopic removal of the target area and acute complications.

    Results: A total of 120 consecutive esophageal endoscopic resection procedures (85 ER-cap, 35 multiband mucosectomy [MBM]) were performed by six endoscopists:109 in Barretts esophagus, 11 for squamous neoplasia; 85 piecemeal endoscopic resections (median 3 specimens, interquartile range 2 - 4 specimens). Complete endoscopic removal was achieved in 111 /120 cases (92.5 %). Six perforations occurred (5.0 %): five were effectively treated endoscopically (clips, covered stent), and one patient underwent esophagectomy. There were 11 acute mild bleedings (9.2 %), which were managed endoscopically. Perforations occurred in ER-cap procedures performed by four participants (7.1 % ER-cap vs. 0 % MBM; P= 0.18), and in 1.7 % of the first 10 endoscopic resections and 8.3 % of the second 10 endoscopic resections per endoscopist (P= 0.26).

    Conclusion: In this intense, structured training program, the first 120 esophageal endoscopic resections performed by six participants were associated with a 5.0 % perforation rate. Although perforations were adequately managed, performing 20 endoscopic resections may not be sufficient to reach the peak of the learning curve in endoscopic resection.

     

    (作者:)
相关评论
用户名: 登录