7046 Endoscopic mucosal resection using a cap method (emr-c) provides safe and effective treatment for early esophageal cancer.

Abstract

Background: As part of an ongoing project between the National Cancer Institutes of the United States and China, 2213 asymptomatic patients in Linzhou, China at high risk for esophageal cancer were screened by endoscopy (EGD) with Lugol's iodine staining (LIS) in April-May, 1999. All 264 patients with severe dysplasia (SD), carcinoma-in-situ (CIS) or early invasive squamous carcinoma (EEC) were considered for EMR-C. (In addition, 361 patients with mild or moderate dysplasia were randomized in a separate chemoprevention trial.) Methods: Endoscopic photographs from the 264 patients who were found to have SD, CIS or EEC at the screening endoscopy were reviewed and those considered candidates for EMR-C had repeat EGD with LIS between 10/25/99-11/5/99. EMR-C was carried out unless the patient had (1) advanced cancer or (2) SD or CIS too diffuse for focal treatment with EMR-C. In such cases, patients were referred for esophagectomy or treated with argon plasma coagulation (APC). In addition, patients having EMR-C underwent optical coherence tomography (OCT). All patients will have repeat EGD with LIS at 1, 4, and 12 months to assess the results of treatment. Successful treatment will be defined as no residual SD or CIS at follow-up. The results will be compared to the results in patients who underwent EMR with a Makuuchi overtube (EMRT)in 1998 in Linzhou. Results: 75 patients had EGD and in these 75 patients 110 lesions amenable to treatment were found (some patients had more than one lesion). 72 EMR-C procedures were performed on 57 lesions in 52 patients. An additional 53 lesions were treated by APC. There were no complications in the APC patients and 2 complications in the 52 patients who underwent EMR-C: one patient had a small perforation which was managed medically and one patient had a circumferential mucosectomy. Conclusions: (1) Endoscopic screening in high-risk groups identifies asymptomatic patients with early esophageal neoplasia amenable to focal endoscopic therapy; (2) EMR-C and APC are feasible endoscopic therapies; (3) EMR-C is particularly appealing since it provides a specimen for pathologic analysis; (4) EMR-C is easier and better tolerated by patients than EMR-T; (5) Results of the one and 4-month EGD followup will be presented. Acknowledgment: Endoscopic equipment and technical support provided by Pentax. Accessory equipment provided by ERBE-USA, Microvasive, CR Bard,Wilson-Cook, and Olympus-Tokyo.