Kaohsiung Medical University Hospital
1
RFA EMR
& ESD
4
5
45
45
40
40
35
35
30
30
25
25
20
20
15
15
10
10
5
5 (
0
(
) 0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
)
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
2000
W.H.O.
http://www.doh.gov.tw/
惡性腫瘤在南臺灣
/
Stool occult blood examination
Guaiac test iFOBT
Lab examination: CEA, SCC, CA72-4…….. UGI series, LGI series CT PET Endoscopy examination
CEA
Positive in 95% of patient with metastatic colon carcinoma, in 20% with localized disease Other condition associated elevated CEA
Other malignant GI tumor Gastroenteritis Pancreatitis Liver cirrhosis Ulcerative colitis Bronchial carcinoma Breast carcinoma Prostate carcinoma smoking
Virtual CT
PET-CT
Esophageal cancer
Pathophysiology: Squamous cell carcinoma- 90%, upper and middle third Adenorcarcinoma-6%, lower third
Most important associated disease: Adenorcarcinoma: Barrett’s esophagus Squamous cell carcinoma: Head & neck cancer
Esophageal cancer and H&N cancer The overall of esophageal Hong Kong:prevalence 13/118(11.0%) cancer in patients of head and neck NTU hospital :to 7/44(15.9%) cancer reach 9.1% 28.0% ED hospital : 14/50(28%)
Gastric Cancer
Pathophysiology: Adenorcarcinoma-more than 90% Others: lymphoma, carcinoid tumor,
gastrointestinal stromal tumor (GIST), ………
Risk factor Environmental factor: H.p. salty food, smoked food Genetic factor: HNPCC precursor lesion: atrophic gastritis, adenoma…
GASTROENTEROLOGY 2008;134:945–952
GASTROENTEROLOGY 2008;134:945–952
Colon Cancer
Pathophysiology: Adenorcarcinoma-98% Others : Lymphoma, Leiomyosarcomas, gastrointestinal stromal tumors(GIST), carcinoids…….
Risk factor Environmental factor: aging. High-fat diet associated disease: UC, Crohn’s disease, FAP, HNPCC precursor lesion: adenoma-to carcinoma
Adenoma-to-Carcinoma Sequence
大腸瘜肉
大腸瘜肉在病理上大致可分成3種 Nonneoplastic hamartoma (juvenile polyp)過誤腫 Hyperplastic mucosal proliferation (hyperplastic polyp)黏膜
增生型瘜肉 Adenomatous polyp腺瘤性瘜肉
大部分的大腸癌從腺瘤性瘜肉轉變成的，約需5~15年
Risk Factor of Colon Cancer
Aging influence of CRC
10
50
1 (B)
28
(A) +
(B)
54
(C) +
(B)
89
A+B+C
123 26
台灣大腸癌發生率 大腸癌的發生率男性大於女性， 以2007年的資料 為例，每10萬人口中，大腸癌男性發生率為 43.41，女性發生率為31.05。
台灣大腸癌早期 診斷的比例偏低
21%(
31%)
XX 1656782X 49.XX.06 ( 51
2 1
0.8cm 0.2cm
)
35 33 29
30 27
27
25
23 22
20 16
((((
15
))))
10
9
9 5
5
0 0
I
II
III
IV
(Pretreatment Evaluation)
Chromoendoscopy Magnifying endoscopy Narrow-Band Imaging Endoscopic ultrasound
(Pretreatment Evaluation)
Chromoendoscopy Magnifying endoscopy Image Enhanced Image
Chromoendoscopy
Indigo-carmine Lugol’s solution Crystal violet
Narrow-Band Imaging(NBI)
Narrow Band Imaging (Olympus)
早期食道癌的內視鏡影像 無法明確彰顯腫瘤之存在
窄頻影像系統可提升早期食道癌的診斷率 其中褐色部分為腫瘤
Fuji Intelligent Color Enhancement (FICE)
i-Scan(Pentex) Surface enhancement
Tone enhancement
Contrast enhancement
World J Gastroenterol 2010 March 7; 16(9): 1043-1049
& Diameter: 9.2mm Channel: 2.8mm
Diameter: 4.0mm Channel: 2.0mm
!! ??
Post gastrectomy with LN dissection: 5265 cases Tumor size Differention/Undiffirention Ulceration Predict LN metastasis
Gastric Cancer (2007) 10: 1–11
Indication of Endoscopic Treatment in Early Gastric Cancer
Gastric Cancer (2007) 10: 1–11
Radiofrequency Ablation(RFA) Endoscopic mucosal resection (EMR) Endoscopic Submucosal Dissection (ESD)
Radiofrequency Ablation
Endoscopic mucosal resection
Endoscopic Submucosal Dissection(ESD)
Endoscopy 2006; 38: 980± ±986
Complication of ESD & EMR
Bleeding Immediate
bleeding Delay bleeding
Perforation Post ESD & EMR stenosis
Techniques in Gastrointestinal Endoscopy 2011 13, 91-94
J Formos Med Assoc 2009;108(1):38–44
Complication
Gastric Cancer (2007) 10: 1–11
Gastric Cancer (2007) 10: 1–11
Gastric Cancer (2007) 10: 1–11
Digestive Endoscopy (2010) 22 (Suppl. 1), S9–S14
Non-surgical management for ESD related perforation
-1 43 year old male Hypopharyngeal cancer Smoking(+瘜 Alcohol(+瘜 Betel Nut(Nut(-瘜
-2
: : 51 : :
:
:
:~10
，
:~10
:
:
: :
1 :
30 (40%) 100~200 10 30
30
2003
2009
2010 ,
，
2.0
25 ( High-grade dysplasia
(2009-12-19)
(2010-11-29)
(2011-07-24)
(2012-03-20)
(2012-07-05)
: GIF-260 : 12- MHz miniprobes (Olympus UM-2R/3R)
+
(2012-7-18)
: GIF-H260Z IPCL-V2
IPCL-V3 IPCL-V3
ESD prednisolone 40mg/ 2
2
ESD in KMUH Total 164 cases
Experience in KMUH 350
Procedure Time(minutes)
300 250 200 150 100 50 0 case
Case Summary of 2015
Period:2015.1.1~2015.12.10 Case number: 49 Esophagus: 11, Stomach:17, Colon:21
Further surgical intervention: 5 Emergent operation: 0, Elective/salvage operation:5 3 procedure fail 1 T1b 1 piecemeal resection but margin(+)
Disease related expire: 0
Success Cases Total 44 cases Stomach 15 cases Adenocarcinoma, pT1a IM with moderate dysplasia Adenoma with moderate dysplasia Low grade GIST Leiomyoma lymphangioma
5 1 1 3 4 1
Esophagus 10 cases Squamous cell carcinoma, pT1 High grade dysplasia Moderate grade dysplasia Esophageal MALToma
5 3 1 1
Colon 19 cases Carcinoma in situ & High grade dysplasia LST adenoma Rectal submucosal tumor(carcinoid)
3 12 4
KMUH
2011
I II III IV Unknown Total
14 13 12 27 1 12 79
17.7 16.5 15.2 34.2 1.3 15.2 100
20 9 14 7 28 1 79
25.3 11.4 17.7 8.9 35.4 1.3 100
KMUH 2008~2011
1
I II III IV
( ) 75 37 49 103 264
1
2
10 5 14 72
(%) 86.1 85.9 71.1 29.1
101
60.9
2
3
3
13 10 23 92
(%) 81.4 70.1 49.1 8.5
16 12 27 96
(%) 74.6 60 31.1 3.6
138
44.7
151
35.9
Log Rank Test p<0.001
~ ~
~ ~
TEL:(07)3121101-7753 E-mail: s339238@ms15.hinet.net
Thanks for Your Attention