Progress in endoscopic treatment for esophageal cancer.

Abstract

Background : Conventional procedures for endoscopic mucosal resection (EMR) and recent procedures for endoscopic submucosal dissection (ESD) are widely used for superficial cancer of esophagus. However, the effect of combining conventional EMR and ESD has not been fully evaluated. Method : We reviewed clinical experience in our hospital regarding EMR for 271 superficial esophageal cancer lesions in 188 patients between April 1998 and June 2007. Conventional EMR (two-channel method, esophageal EMR-tube method and EMR cap-fitted method) and ESD were used. Result : The rate of local recurrence after EMR (conventional EMR+ESD) was 4.4% (12/271). The rate of local recurrence after conventional EMR was 8.0% (12/150). However, the rate after ESD was 0 % (0/121). The rate of complete resection after conventional EMR was 70% (105/150) whereas that rate for ESD was 94.2% (114/121). There are 12 recurrent lesions after conventional EMR, including 10 cases undergoing a second ESD or EMR procedure, one case that underwent surgical treatment and one case treated by chemo radiation therapy. Conclusion : The rate of complete resection by ESD is higher than that by EMR. Moreover, the rate of local recurrence after ESD was lower than that after EMR. Therefore, ESD is considered a more useful method of treating superficial esophageal cancer.