Prospective feasibility study on the use of multiband mucosectomy for endoscopic resection of early squamous neoplasia in the esophagus

Y. M. Zhang; D. F. Boerwinkel; S. He; B. L. A. M. Weusten; L. Y. Xue; D. E. Fleischer; N. Lu; S. M. Dawsey; S. M. Zuo; X. M. Qin; L. Z. Dou; J. J. G. H. M. Bergman; G. Q. Wang

doi:10.1055/s-0032-1326011

Endoscopy, Inhaltsverzeichnis

Endoscopy 2013; 45(03): 167-173
DOI: 10.1055/s-0032-1326011

Original article

Prospective feasibility study on the use of multiband mucosectomy for endoscopic resection of early squamous neoplasia in the esophagus

Y. M. Zhang^*

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

D. F. Boerwinkel^*

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands

,

S. He

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

B. L. A. M. Weusten

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands

³Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands

,

L. Y. Xue

⁶Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China

,

D. E. Fleischer

⁵Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

,

N. Lu

⁶Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China

,

S. M. Dawsey

⁴Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA

,

S. M. Zuo

⁶Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China

,

X. M. Qin

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

L. Z. Dou

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

J. J. G. H. M. Bergman

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands

,

G. Q. Wang

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

› Institutsangaben

Abstract

Background and study aims: Endoscopic resection for esophageal squamous high-grade intraepithelial neoplasia (HGIN) or intramucosal cancer (esophageal squamous cell carcinoma [ESCC]) with the endoscopic resection cap technique is technically difficult, and requires submucosal lifting and multiple snares for piecemeal resections. Multiband mucosectomy (MBM) is an easy-to-use endoscopic resection technique and may be the modality of choice in China, where ESCC is extremely prevalent. The aim of the current study was to prospectively evaluate MBM for piecemeal endoscopic resection of squamous neoplasia of the esophagus.

Methods: Patients with HGIN/ESCC and no signs of submucosal invasion or metastatic disease were included in the study. Lesions were delineated using electrocoagulation and resected using the MBM technique. Endpoints were procedure time, endoscopic radicality, complications, histology of the endoscopic resection specimens, and absence of HGIN/ESCC at the endoscopic resection scar during follow-up.

Results: A total of 41 patients (26 male; mean age 61 years) underwent MBM; all lesions were visible with white light endoscopy (median length 5 cm, interquartile range [IQR] 4 – 6 cm; median circumferential extent 42 %, IQR 25 – 50 %). Median procedure time was 12 minutes (IQR 8 – 24 minutes). Median number of resections was 5 (IQR 3 – 6). Endoscopic complete resection was achieved in all lesions. There was one perforation, which was treated by application of clips. No other complications were observed. The worst histology was ESCC (n = 19), HGIN (n = 17), middle grade intraepithelial neoplasia (n = 4), and normal squamous epithelium (n = 1). Endoscopic follow-up at 3 months showed HGIN at the endoscopic resection scar in two patients, which was effectively treated endoscopically, and showed normal squamous epithelium in all patients at final follow-up (median 15 months, IQR 12 – 24 months).

Conclusion: This first prospective study on MBM for piecemeal endoscopic resection of early esophageal squamous neoplasia showed that MBM was effective for the complete removal of lesions with short procedure time, few complications, effective histological assessment of resected specimens, and durable treatment effect.

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Referenzen

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