2133 Hybrid Argon Plasma Coagulation Therapy for Early Esophageal Squamous Cell Carcinoma

Abstract

INTRODUCTION: Squamous cell carcinoma is common in Asia, accounting for most cases of esophageal cancer throughout the world, whereas adenocarcinoma is more common in the Western world. Overall, neoplasms of the esophagus carry a poor prognosis. Treatment options depend on the stage of the disease. Endoscopic therapy may be considered for early disease as endoscopic resection is a safe and minimally invasive treatment option for Tis and T1a esophageal malignancies. Esophagectomy is necessary for invasive disease. CASE DESCRIPTION/METHODS: A 56 years-old male was found to have non-circumferential mucosal irregularities between 25-27 cm from the incisors (Figure 1). Biopsy of the irregular mucosa revealed atypical squamous proliferation, consistent with squamous cell carcinoma in-situ (Tis). Subsequent endoscopic ultrasound (EUS) evaluation revealed thickened mucosa without the involvement of the deep mucosa or muscularis propria. Endoscopic mucosal resection (EMR) was performed and pathology confirmed clear margins. Subsequent surveillance EGD revealed the persistence of atypical squamous mucosa however extensive post-EMR scarring prevented repeat mucosal resection. The patient refused surgical intervention and the decision was made to pursue hybrid APC ablation of the remaining esophageal mucosa. The esophageal mucosa was lavaged with Lugoll’s Iodine to expose the affected squamous epithelium. The affected areas were then lifted with a solution of saline and methylene blue and ablated using argon plasma coagulation at 50 W (Figure 2). DISCUSSION: APC has been successfully used in similar applications; to ablate tissue margins after endoscopic resection of early neoplasia. The development of hybrid APC and its inherent improved safety profile allows for an extension of its application to include primary treatment of dysplastic and neoplastic lesions. In one recent study, tissue damage was limited to the submucosal layer regardless of application time. This case describes an effective novel use of Hybrid APC for treatment of Tis esophageal squamous cell carcinoma.