3532 Endoscopic mucosal resection of superficial neoplastic esophageal lesions: macroscopic and histological results.

Abstract

Endoscopic mucosal resection (EMR) is a new endoscopic method for the treatment of superficial neoplastic lesions of the digestive tract. The goal of this study is to assess the feasibility and results of EMR in esophageal dysplastic lesions and superficial cancers. Patients and methods: 31 EMR were performed in 27 patients (pts) (23 men, 4 women, median age: 67 years). The 31 lesions were 3 squamous cell high grade dysplasias (HGD), 4 HGD on Barrett, 20 squamous cell cancers and 4 adenocarcinomas. Eight pts had been previously treated using photodynamic therapy (PDT). Following lugol or indigocarmine dying, median lesion diameter was 15mm (range: 10-40 mm). Lesions were classified uT0N0 or uT1N0 on standard EUS (13 cases) or uTmuqN0 on 20MHz miniprobe EUS (18). Inoue method (transparent cap at the tip of the endoscope and asymetrical snare) was used in all pts. Immediate results: resection was in bloc in 23 cases or by fragments (2-6) in 8 cases. Five lesions (HGD on Barrett: 1, squamous cell carcinoma: 4) were not found on the specimen in pts previously treated using PDT. Concerning the 26 lesions found on the specimen, resection was considered macroscopically complete by the endoscopist in 24 cases. However, on histology, resection was in sano in only 4 cases. Indeed, 1- analysis of the specimen margins was not possible due to coagulation artifacts in 5 cases; 2- resection was non in sano laterally alone in 10 cases and non in sano both in depth and laterally in 4 cases. Submucosal carcinomatous invasion was detected in 6 cases. Follow-up: due to their age and submucosal invasion or incomplete resection, 6 pts had a complementary radiochemotherapy (4 cases) or a surgical resection (2 cases). 1 pt died from another cancer. 18 pts were reexamined endoscopically (mean: 6 months) without lesions and 1 had a persistant lesion treated by complementary PDT. Side-effects: One out of 3 bleedings required an endoscopic clipping. No symptomatic perforation was observed despite muscular resection in 2 pts. Conclusion: These results demonstrate the feasibility and safety of the method and the advantage of EMR to provide a precise histological diagnosis. Endoscopic assessment of results is satisfactory; however, histology shows that the section frequently passes on the margins of the lesion especially laterally and technical improvements are necessary to enlarge the resection. Endoscopic mucosal resection (EMR) is a new endoscopic method for the treatment of superficial neoplastic lesions of the digestive tract. The goal of this study is to assess the feasibility and results of EMR in esophageal dysplastic lesions and superficial cancers. Patients and methods: 31 EMR were performed in 27 patients (pts) (23 men, 4 women, median age: 67 years). The 31 lesions were 3 squamous cell high grade dysplasias (HGD), 4 HGD on Barrett, 20 squamous cell cancers and 4 adenocarcinomas. Eight pts had been previously treated using photodynamic therapy (PDT). Following lugol or indigocarmine dying, median lesion diameter was 15mm (range: 10-40 mm). Lesions were classified uT0N0 or uT1N0 on standard EUS (13 cases) or uTmuqN0 on 20MHz miniprobe EUS (18). Inoue method (transparent cap at the tip of the endoscope and asymetrical snare) was used in all pts. Immediate results: resection was in bloc in 23 cases or by fragments (2-6) in 8 cases. Five lesions (HGD on Barrett: 1, squamous cell carcinoma: 4) were not found on the specimen in pts previously treated using PDT. Concerning the 26 lesions found on the specimen, resection was considered macroscopically complete by the endoscopist in 24 cases. However, on histology, resection was in sano in only 4 cases. Indeed, 1- analysis of the specimen margins was not possible due to coagulation artifacts in 5 cases; 2- resection was non in sano laterally alone in 10 cases and non in sano both in depth and laterally in 4 cases. Submucosal carcinomatous invasion was detected in 6 cases. Follow-up: due to their age and submucosal invasion or incomplete resection, 6 pts had a complementary radiochemotherapy (4 cases) or a surgical resection (2 cases). 1 pt died from another cancer. 18 pts were reexamined endoscopically (mean: 6 months) without lesions and 1 had a persistant lesion treated by complementary PDT. Side-effects: One out of 3 bleedings required an endoscopic clipping. No symptomatic perforation was observed despite muscular resection in 2 pts. Conclusion: These results demonstrate the feasibility and safety of the method and the advantage of EMR to provide a precise histological diagnosis. Endoscopic assessment of results is satisfactory; however, histology shows that the section frequently passes on the margins of the lesion especially laterally and technical improvements are necessary to enlarge the resection.