Resection Of Early Esophageal Cancer Research Articles

Endoscopic mucosal resection for early esophageal cancer

In the United States and Europe, the focus of endoscopic treatment for esophageal cancer has been the palliative management of advanced cancers. In Japan, where cancers of the esophagus and stomach have a high prevalence, the focus has been the early detection of esophageal cancer and the development of endoscopic modalities to curatively treat cancer. Advances in the endoscopic and endosonographic diagnosis of early esophageal cancer have paralleled the development of endoscopic resectional techniques, collectively referred to as endoscopic mucosal resection (EMR). EMR has achieved a high level of sophistication in Japan, where endoscopists use double-lumen endoscopes, specia overtubes, and innovative accessories to achieve complete and safe excision of early esophageal cancer. In appropriately selected patients, EMR offers an attractive alternative to conventional surgical management. Interest for EMR techniques is growing in the United States and Europe as a result of increased awareness of early cancer and the potential for cure endoscopically.

Endoscopic Ultrasonography in Diagnosis and Mucosal Resection for Early Esophageal Cancer

Endoscopic Ultrasonography in Diagnosis and Mucosal Resection for Early Esophageal Cancer

粘膜切除術後のレーザー治療追加による遅発性食道穿孔の1例

粘膜切除術後のレーザー治療追加による遅発性食道穿孔の1例

Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer.

Endoscopic mucosal resection of early esophageal cancer has increasingly proved to be an effective treatment modality, especially if the tumor has not invaded the muscularis mucosae. Different techniques have been introduced, using an overtube, double-channel endoscope, or suction cap. We have not found that these devices are required for snare resection in the esophagus. Over a period of two years (1994-1996), seven patients (five men and two women, age range 59-88) with early esophageal cancer defined by endosonography (3 cm or less in size, limited to the submucosal layer) were treated using a simplified technique of endoscopic snare resection using a monopolar diathermic polypectomy snare made of monofilament steel wire. The snare was positioned around the lesion, and then closed while pressing the snare against the mucosa and applying suction to draw the lesion into the snare. Pure coagulation current was used for resection. If necessary, a piecemeal technique was used to achieve complete removal. Complete removal was achieved in one session in all seven cases. No complications were observed. Two patients underwent radical surgery with no tumor remnant or metastatic lymph node in the resected specimen. All patients have remained free of recurrence during a median follow-up period of seven months (range 3-22 months). Two patients died of cardiovascular disease four and eight months after endoscopic mucosal resection. Small early esophageal cancer can be safely removed with a simplified method of endoscopic snare resection using a standard monofilament polypectomy snare.

Endoscopic Mucosal Resection for Early Esophageal Cancer

Endoscopic Mucosal Resection for Early Esophageal Cancer

食道粘膜癌に対する内視鏡的粘膜切除の検討

国立がんセンター中央病院で1991年1月から1995年2月までの食道内視鏡的粘膜切除（EMR）を施行した40症例46病変について検討した。症例の年齢は46歳から81歳まで平均63.8歳であり，男女比は35 : 5であった。部位はImが32病変と多く，次はEiの9病変であった。組織型は全例扁平上皮癌であり，主肉眼型は0-Ⅱcが最も多く34病変（74％），0-Ⅱaが6病変（13％），0-Ⅱbが6病変（13％）で，切除方式は分割切除が31病変（67％）であり残りは一括切除であった。深達度はep，mm1が20例，㎜2が13例，mm3が5例，smが2例であった。EMRは食道粘膜癌に対する根治療法として有用であると考えられ，合併症としての狭窄はブジーを使用することにより解消可能であるため，全周性切除となる病巣に対しても積極的に行うべきである。また，完全切除と病理組織学的に判定された症例でも再発することがあるため，治療後すべての症例で十分な経過観察が必要である。今後は十分な症例を重ねた後，適応条件の拡大も検討必要があると思われた。