Endoscopic mucosectomy of early esophageal cancer
Momma, K.; Yoshida, M.; Yamada, Y.; Tajima, T.; Iwasaki, Y.
Stomach and Intestine 28(2): 141-151
ISSN/ISBN: 0536-2180 Accession: 008603668
We evaluated the clinical and pathological characteristics of 40 patients who underwent endoscopic mucosectomy for esophageal mucosal lesions (28 intraepithelial cancers, 9 mucosal cancers, 1 submucosal cancer, and 2 atypical epithelium lesions). Pathological diagnosis of biopsy specimens before endoscopic treatment was as follows: 33 squamous cell carcinomas, 3 atypical epitheliums, and 2 regenerative epitheliums. One out of 2 cases of atypical epitheliums was found to have a small focal squamous cell carcinoma in the mucosectomy specimen. Accuracy rate of pre-procedural diagnosis of invasivity was 88%. The completeness of endoscopic resection could be confirmed by identification of normal mucosa around a lesion in the resected specimen and no iodine unstained area surrounding an iatrogenic ulcer. Two out of 22 cases of intraepithelial carcinoma had local recurrences alter endoscopic piecemeal resections. They were completely removed by endoscopic mucosectomies. Five cases had a small amount of bleeding from the iatrogenic ulcers, which were successfully controlled by conservative treatments. Two cases developed esophageal stenosis after circular resection of the esophagus. Minimal mediastinal emphysema was noted in one case, but there was no sign of perforation in the esophagogram and it disappeared in ten days. Forty patients with endoscopic mucosectomy had been followed for 19.9 months on the average (range from 1 to 60 months). One patient was expired by an advanced cancer arising from other organ, which had no evidence of recurrence of esophageal cancer. There was a case of incomplete resection, which developed a local recurrence and underwent surgical resection. There were 3 cases of metachronous multifocal cancers which could be resected endoscopically.