Efficacy of argon plasma coagulation for treatment of superficial esophageal carcinoma

Abstract

Recently, endoscopic submucosal dissection (ESD) has been widely used as a therapeutic procedure for mucosal cancer of the digestive tract, including esophageal disease. However, ESD may result in bleeding, perforation and post-treatment stenosis of the esophagus. In high-risk patients with underlying disease, ESD should be avoided for treatment of superficial esophageal carcinoma. Argon plasma coagulation (APC) has been reported to be a safe and useful procedure for the management of gastric mucosal cancer. We report here two cases of superficial esophageal carcinoma and high-grade dysplasia of the esophagus which were treated using APC.
Case 1 : An 84-year-old man─with malignant lymphoma─was diagnosed with superficial squamous cell carcinoma of the esophagus. Since he had been receiving steroid therapy and had renal dysfunction, he underwent APC in preference to endoscopic resection to treat the esophageal carcinoma. After ablation of the lesion by APC, the ablated epithelial layer was removed by endoscopic distal attachment (soft hood) and additional APC was performed on the lesion. The esophageal carcinoma disappeared.
Case 2 : A 55-year-old man─who had lower pharyngeal cancer─was diagnosed with early esophageal cancer. Since he had multiple tiny lesions unstained by iodine, he underwent chemoradiotherapy for the esophageal cancer. High-grade dysplasia of the esophagus developed 20 months after CRT. After repeated APC therapy, the esophageal dysplasia disappeared.
No complications were observed in either case. This suggests that APC is a safe and effective treatment for superficial esophageal carcinoma that cannot be resected endoscopically because of underlying severe disease, as well as treatment of local recurrence after chemoradiotherapy.