Endoskopik submukozal diseksiyon ile rektal intramukozal karsinoma olgusunun tedavisi

Endoskopik submukozal diseksiyon; kesici aygıtların kullanımı ile submukozaya sınırlı lezyonların tek parça halinde çıkartılmasını sağlayan bir uygulamadır. Endoskopik submukozal diseksiyonun, endoskopik mukozal rezeksiyona kıyasla bazı avantaj ve dezavantajları vardır. Önemli avantajları; 1) Endoskopik submukozal diseksiyon ile 2 cm'den büyük lezyonların tek parça halinde çıkartılması, 2) Nüks lezyonların endoskopik submukozal diseksiyon ile çıkarılmasının mümkün olması, 3) Rezeke edilecek lezyonun çap ve şeklini kontrol etmeye çok uygun olmasıdır. Burada kardiyak risk faktörlerinden dolayı opere edilemeyen, rektumda 3 cm çapında lezyonu olan olgunun endoskopik submukozal diseksiyon ile başarılı şekilde tedavisi sunulmuştur.

Anahtar Kelimeler:

Submukozal diseksiyon, intramukoza, karsinoma insitu

Treatment of rectal intramucosal carcinoma by endoscopic submucosal dissection: A case report

Endoscopic submucosal dissection is a safe method that provides en bloc resection of submucosal lesions using cutting blade devices. Endoscopic submucosal dissection also has some advantages and disadvantages when compared with endoscopic mucosal resection. The important advantages are: 1) Endoscopic submucosal dissection provides en bloc resection of lesions having a diameter of more than 2 cm. 2) It is possible to remove relapsed lesions with endoscopic submucosal dissection. 3) Endoscopic submucosal dissection is more convenient for controlling the size and shape of the lesion to be resected. Herein we report a case with a 3-cm lesion in the rectum successfully resected by endoscopic submucosal dissection who could not be operated because of cardiac risk factors.

Keywords:

Submucosal dissection, intramucosa, carcinoma insitu,

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Yamamoto H, Kawata H, Sunada K, et al. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 2002;56:507-12.
Yahagi N, Fujishiro M, Kakushima N, et al. Endoscopic submucosal dissection for early gastric cancer using the tip of an electro-sergical snare (thin type). Dig Endosc 2004;16:34-8.
Fujishiro M, Yahagi N, Nakamura M, et al. Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 2006;38:493-7.
Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006;4: 688-94.
Fujishiro M. Endoscopic resection for early gastric cancer. In: Kaminishi M, Takubo K, Mafune K (Eds). The diversity of gastric carcinoma; Pathogenesis, diagnosis, and therapy. Springer-Verlag Tokyo. 2005:243-52.
Hosokawa K, Yoshida S. Recent advances in endoscopic mucosal resection for early gastric cancer. Gan To Kagaku Ryoho 1998;25:476-83.
Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005;3(Suppl 1):67-70.
Yamamoto H, Yahagi N, Oyama T et al. Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 2005;37:764-8.
Toshio U, Jun K, Yoshiro K et al. Clinical impact of endoscopic submucosal dissection of large laterally spreading tumors in the colorectum. Gastrointestinal Endoscopy 2007;65:AB255.
Kashida H. Kudo SE. Early colorectal cancer: concept, diagnosis and management. ‹nt J Clin Oncol 2006;11:1-8.
Kudo SE, Kashida H. Flat and depressed lesions of the colorectum. Clin Gastroenterol Hepatol 2005;3:33-6.
Huang Q, Fukami N, Kashida H, et al. Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc 2004;60:520-6.
Saitoh Y, Obara T, Einami K, et al. Efficacy of high-frequency ultrasound probes for the preoperative staging of invasion depth in flat and depressed colorectal tumors. Gastrointest Endosc 1996;44:34-9.
Tsuruta O, Kawano H, Fujita M, et al. Usefulness of the high-frequency ultrasound probe in pretherapeutic staging of superficial-type colorectal tumors. Int J Oncol 1998;13:677-84.
Harada N, Hamada S, Kubo H, et al. Preoperative evaluation of submucosal invasive colorectal cancer using a 15-MHz ultrasound miniprobe. Endoscopy 2001;33:237-40.
Fujishiro M, Yahagi N, Kashimura K, et al. Tissue damage of different sub-mucosal injection solutions for EMR. Gastrointest Endosc 2005;62:933–42.
Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006;63:243–9.