Clinical evaluation of endoscopic therapy in patients with early esophageal cancer and precancerous lesion

Abstract

Objective To explore the application value and safety of endoscopic submucosal dissection (ESD) and multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and precancerous lesion. Methods Seventy-two cases of early esophageal cancer and precancerous lesion that underwent endoscopic therapy from January 2010 to April 2016 in the Wuhan Central Hospital were registered for the study. The patients in the ESD group (60 cases) received ESD, while the patients in the EMBM group (12 cases) received EMBM. Retrospective analyses were made on such indicators as surgical time and treatment results, pathological diagnosis, incidence rates of long and short-term complications, and therapeutic efficacy. Results Pathological results indicated that there were 28 cases of low-grade intraepithelial neoplasm (LGIN) precancerous lesion, 16 cases of high-grade intraepithelial neoplasm ( HGIN) precancerous lesion and 16 cases of early esophageal cancer (EEC). The lengths of the foci were 2-6 cm, with an average length of(3.2±0.6)cm and the average surgical time was(82.1±7.5)min. Pathological detection showed that in the EMBM group there were 3 cases of LGIN, 4 cases of HGIN and 5 cases of EEC. The lengths of the foci were 3-10 cm, with an average length of(4.8±0.8)cm and the average surgical time was(35.0±5.1) min. The rate of retrosternal pain after surgery was 41.7% (30/72), the rate of hemorrhage was 1.4%(1/72), and the rates of perforation, esophageal stricture, abdominal pain and fever were respectively 1.4%(1/72), 5.6%(4/72), 11.1%(8/72) and 11.1%(8/72). Pathological detection indicated that in the ESD group complete resection in the cases of LGIN was 96.4%(27/28), complete resection in the cases of HGIN was 93.8%(15/16)and complete resection in the cases of EEC was 100%(16/16). Pathological detection after surgery indicated that the incision edges of the foci were all negative. In the ESD group, there were no cases with lesions penetrating into the muscular layer of mucosa and further into the submucous layer, while there were 2 cases in the EMBM group with lesions penetrating into the submucous layer. Examination by gastroscopy in 62 cases 2 months after surgery revealed that the healing rate of the wound surface was 100% (62 /62), and there was only 1 case that had residual incomplete healing. Fifty-eight cases had gastroscopy 6 months after surgery, and detection results indicated that there was only 1 case that had local recurrence, and 56 cases had gastroscopy 12 months after surgery, and detection results revealed that there was no case of local recurrence. 16.7% of the patients(2/72)that had residual foci or local recurrence were all the patients from the EMBM group. Conclusions ESD and EMBM were safe and effective therapeutic methods for the treatment of early esophageal cancer and precancerous lesion. ESD could completely remove foci with just one incision, with the advantages of easy pathological detection, low rates of recurrence and complication, and low injury, while EMBM on the other hand was a more prompt, safe and effective method for the treatment of lesion with broad foci, however it could not provide complete pathologic data. Key words: Esophageal neoplasm; Precancerous state; Endoscopic submucosal dissection; Endoscopic multi-band mucosectomy