Background and study aims: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. Patients and methods: A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasias or mucosal (m) T1 carcinomas were treated with repeated EMR until there was complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. Results: There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91 %). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26 %). The 5-year survival rate was 58 %, while the disease specific 5-year survival rate was 95 %. Conclusions: EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.
References
-
1
Makuuchi H, Machimura T, Sugihara T. et al .
Endoscopic diagnosis and treatment of the mucosal carcinoma of the esophagus.
Endoscopia Digestiva.
1990;
2
447-452
-
2
Makuuchi H, Machimura , Soh Y. et al .
Endoscopic mucosectomy for mucosal carcinoma in the esophagus.
Jpn J Surg Gastroenterol.
1991;
24
2599-2603
-
3 Makuuchi H, Machimura T, Mizutani K. et al .Endoscopic mucosal resection for early carcinomas of the esophagus. In: Takahashi T (ed.) Recent advances in management of digestive cancer. Tokyo; Springer Verlag 1993: 97
-
4
Inoune H, Tani M, Nagal K. et al .
Treatment of esophageal and gastric tumors.
Endoscopy.
1993;
31
47-55
-
5
Makuuchi H.
Endoscopic mucosal resection for early esophageal cancer - indication and techniques.
Dig Endosc.
1996;
8
175-179
-
6 Japanese Society for Esophageal Diseases .Guidelines for the clinical and pathological studies of carcinoma of the esophagus. Tokyo; Kanehara & Co 1999
-
7 Watanabe H, Jass J R, Sobin L H. Histological typing of esophageal and gastric tumors, 2nd edn. Berlin; Springer 1990
-
8
Schlemper R J, Riddell R H, Kato Y. et al .
The Vienna classification of gastrointestinal epithelial neoplasia.
Gut.
2000;
51
AB120 (3537)
-
9 Sano M, Okuda S, Tamura H. et al .Esophagoendoscopy using Lugol’s staining; diagnosis of esophageal cancer. In: Takemoto T, Kawai K, Ida K, Suzuki S (eds) Chromoendoscopy for gastrointestinal cancer. Tokyo; Igaku Shoin 1978: 13-24
-
10
Inoue H, Takeshita K, Hori H. et al .
Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach and colon mucosal lesions.
Gastrointest Endosc.
1993;
39
58-62
-
11
Inoue H, Noguchi O, Saito N. et al .
Endoscopic mucosal resection for early cancer using a pre-looped plastic cap.
Gastrointest Endosc.
1994;
40
263-264
-
12
Inoue H.
Endoscopic mucosal resection for esophageal and gastric mucosal cancers.
Can J Gastroenterol.
1998;
12
355-359
-
13 Hamilton S R, Aaltonen L A (eds). WHO classification of tumors. Tumors of the digestive system. Lyon; IARC Press 2000
-
14
Bollschweiler E, Baldus S E, Schroder W. et al .
High rate of lymph-node metastasis in submucosal esophageal squamous cell carcinomas and adenocarcinomas.
Endoscopy.
2006;
38
149-156
-
15
Shimada H, Nabeya Y, Matsubara H. et al .
Prediction of lymph node status in patients with superficial esophageal carcinoma: analysis of 160 surgically resected cancers.
Am J Surg.
2006;
191
250-254
-
16
Eguchi T, Nakanishi Y, Shimoda T. et al .
Histopathogical criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases.
Mod Pathol.
2006;
19
475-480
-
17 Huguier M, Flahault A. Biostatistiques au quotidien. Amsterdam; Elsevier 2000
-
18
Stein H J, Feith M, Bjorn L D. et al .
Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection.
Ann Surg.
2005;
242
566-575
-
19
Tachibana M, Kinugasa S, Shibakita M. et al .
Surgical treatment of superficial esophageal cancer.
Langenbecks Arch Surg.
2006;
391
304-321
-
20
Fujita H, Sueyoshi S, Yamana H. et al .
Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophageactomy.
World J Surg.
2001;
25
424-431
-
21
Shimizu Y, Tsukagoshi H, Fujita M. et al .
Long-term outcome alter endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper.
Gastrointest Endosc.
2002;
56
387-390
-
22
Pech O, Gossner L, May A. et al .
Endoscopic resection of superficial esophageal squamous cell carcinomas: western experience.
Am J Gastroenterol.
2004;
99
1226-1232
-
23
Vieth M, Ell C, Gossner L. et al .
Histological analysis of endoscopic resection from 326 patients with Barrett’s esophagus and early neoplasia.
Endoscopy.
2004;
36
776-781
-
24
Narahara H, Iishi H, Tatsuta M. et al .
Effectiveness of endoscopic mucosal resection with submucosal saline injection technique for superficial squamous carcinomas of the esophagus.
Gastrointest Endosc.
2000;
52
730-734
-
25
Nomura T, Boku N, Ohtsu A. et al .
Recurrence after endoscopic mucosal resection for superficial esophageal cancer.
Endoscopy.
2000;
32
277-280
-
26
Katada C, Muto M, Manabe T. et al .
Local recurrence of squamous-cell carcinoma of the esophagus after EMR.
Gastrointest Endosc.
2005;
61
219-225
-
27
Bradburn M J, Clark T G, Love S B. et al .
Survival analysis part III: multivariate data analysis - choosing a model and assessing its adequacy and fit.
Br J Cancer.
2003;
89
605-611
-
28
Peduzzi P, Concato J, Feinstein A R. et al .
Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates.
J Clin Epidemiol.
1995;
48
1503-1510
M. Ciocirlan, MD
Hépatogastroentérologie
Hôpital Édouard Herriot
5 Place d’Arsonval
69437, Lyon
France
Email: ciocirlanm@yahoo.com
