The macroscopic and histological effects of argon plasma coagulation followed by subepithelial ablation on early esophageal squamous cell carcinoma using magnifying endoscopy with blue laser imaging

Abstract

Background Argon plasma coagulation (APC) followed by subepithelial ablation (termed APC-SEA) is an effective means of treating early esophageal squamous cell carcinomas (EESCCs). However, the mechanism of tissue exfoliation after the first ablation was unknown. This study aimed to determine the characteristics of the exfoliated esophageal mucosa after the first ablation. Methods We examined 13 EESCC lesions. We then marked them by APC. We removed the epithelium exfoliated by the initial ablation procedure and performed magnifying endoscopy with blue laser imaging for the exfoliated area and a second ablation procedure for subepithelial degeneration. The exfoliated tissue was examined histopathologically. Results The basement membrane was not visible on the surface of the exfoliated samples. Among the 13 exfoliated specimens, 9 were confirmed to have viable carcinoma. The basal cell layer was exposed homogeneously on most of the surface of the exfoliated esophagus. In the intraepithelial papillae, basement membrane was dissected at the same level as the exfoliated surface surrounding it, or preserved intact. Conclusion The basal cell layer containing carcinoma in situ was exposed homogeneously on most of the surface of the esophagus just before the second ablation procedure. A second ablation procedure was found to be essential for treating EESCC.