Successful En-Bloc Resection of Large Superficial Esophageal Cancer Using Sodium Hyaluronate and Small-Caliber-Tip Transparent Hood

Abstract

(Background) En-bloc resection by endoscopic mucosal resection (EMR) is desirable to facilitate accurate histopathological assessment of tissue specimens, and it is indispensable in the superficially-spreading type of esophageal cancer. A new EMR method using sodium hyaluronate and a small-caliber-tip transparent hood (Fujinon DH-15GR, Fuji Photo Optical Co., Ltd., Omiya, Japan) has been developed at our institution for use in endoscopic en-bloc resection of large superficial gastric and colonic lesions. In addition, two large superficially-spreading type of esophageal cancers were endoscopically resected using this method. (Case 1) An 81-year old man was admitted to our hospital with heart burn. Conventional endoscopy showed a superficially-spreading type esophageal cancer. Chromoscopic findings using iodine staining showed an unstained area about 5cm long occupying about three-quarters of the circumference of the esophagus. EMR using this method was performed without significant complication, and en-bloc resection was successful. The lesion was an intramucosal scquamous cell carcinoma (SCC), measuring 50 × 24mm in diameter. (Case 2) An 86-year old man was admitted to our hospital to treat residual esophageal cancer after EMR and irradiation with 60 Gys 3 years earlier. Endoscopic and chromoscopic findings using iodine staining showed an unstained area 3cm long occupying half the circumference of the esophagus. Complete resection was achieved using this method and there were no complications. The lesion was an intramucosal SCC, 32 × 25mm in diameter. (Discussion) Injection of sodium hyaluronate creates prolonged submucosal thickening, and the small-caliber-tip transparent hood allows good visualization of the targeted submucosal tissue. We conclude that this new method is safe and useful for large superficially-spreading esophageal cancers, even for residual lesions.