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Abstract

We thank Shimizu et al for the helpful comments. We have read the article by Shimizu et al.1Shimizu Y. Yamamoto J. Kato M. et al.Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma.Gastrointest Endosc. 2006; 64: 255-259Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar We had performed endoscopic submucosal dissection (ESD) for pharyngeal low-grade dysplasia (LGD), mainly for the following two reasons. The first is that the endoscopic diagnosis by means of the intraepithelial papillary capillary loop pattern and the histologic diagnosis might differ in some patients. Shimizu et al say that all LGDs showed a type IV pattern. However, Inoue et al2Inoue H. Minami H. Sato Y. et al.High-magnification endoscopic diagnosis of meso- and hypopharyngeal cancer [in Japanese with English abstract].Stomach and Intestine. 2010; 45: 217-226PubMed Google Scholar have reported that not all lesions with a type IV pattern were LGD. There had been no other reports on that point when we started the research. To confirm the accuracy of endoscopic diagnosis, we carried out ESD to diagnose the lesions histologically. In the present study, 16 of 26 (62%) lesions with a type IV pattern were LGD, and the remaining 10 of 26 (38%) were high-grade dysplasia or carcinoma in situ (HGD/CIS). The second reason we performed ESD is that the adequate management strategy for pharyngeal LGD has not been established, as Shimizu et al mentioned in their letter. We think that our data are fundamental in establishing the strategy.Because we confirmed the diagnostic accuracy of the intraepithelial papillary capillary loop pattern and the histologic diagnosis in the present study, we had not performed ESD in patients with pharyngeal LGD since then. Now we can report that we have followed them up endoscopically every 6 to 12 months. We had endoscopically followed up 15 patients with pharyngeal LGD at the end of 2012. None of the lesions changed in size or appearance during a median period of 23.8 months. As Shimizu et al commented, we should establish the adequate management strategy for pharyngeal LGD. We would like to report detailed data on patients with pharyngeal LGD during a longer observation period in the near future. We thank Shimizu et al for the helpful comments. We have read the article by Shimizu et al.1Shimizu Y. Yamamoto J. Kato M. et al.Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma.Gastrointest Endosc. 2006; 64: 255-259Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar We had performed endoscopic submucosal dissection (ESD) for pharyngeal low-grade dysplasia (LGD), mainly for the following two reasons. The first is that the endoscopic diagnosis by means of the intraepithelial papillary capillary loop pattern and the histologic diagnosis might differ in some patients. Shimizu et al say that all LGDs showed a type IV pattern. However, Inoue et al2Inoue H. Minami H. Sato Y. et al.High-magnification endoscopic diagnosis of meso- and hypopharyngeal cancer [in Japanese with English abstract].Stomach and Intestine. 2010; 45: 217-226PubMed Google Scholar have reported that not all lesions with a type IV pattern were LGD. There had been no other reports on that point when we started the research. To confirm the accuracy of endoscopic diagnosis, we carried out ESD to diagnose the lesions histologically. In the present study, 16 of 26 (62%) lesions with a type IV pattern were LGD, and the remaining 10 of 26 (38%) were high-grade dysplasia or carcinoma in situ (HGD/CIS). The second reason we performed ESD is that the adequate management strategy for pharyngeal LGD has not been established, as Shimizu et al mentioned in their letter. We think that our data are fundamental in establishing the strategy. Because we confirmed the diagnostic accuracy of the intraepithelial papillary capillary loop pattern and the histologic diagnosis in the present study, we had not performed ESD in patients with pharyngeal LGD since then. Now we can report that we have followed them up endoscopically every 6 to 12 months. We had endoscopically followed up 15 patients with pharyngeal LGD at the end of 2012. None of the lesions changed in size or appearance during a median period of 23.8 months. As Shimizu et al commented, we should establish the adequate management strategy for pharyngeal LGD. We would like to report detailed data on patients with pharyngeal LGD during a longer observation period in the near future. What is an adequate management strategy for pharyngeal low-grade dysplasia?Gastrointestinal EndoscopyVol. 77Issue 6PreviewWe have read with great interest the article by Kuwabara et al,1 who studied the clinical features of pharyngeal intraepithelial neoplasias and outcomes of treatment by endoscopic submucosal dissection (ESD). The authors performed ESD for patients with not only high-grade dysplasia or carcinoma in situ (HGD/CIS) but also low-grade dysplasia (LGD) and concluded that ESD appears to be an effective treatment for pharyngeal intraepithelial neoplasias. Full-Text PDF