Long-Term Outcome After Endoscopic Mucosal Resection Of Superficial Esophageal Malignant Tumors

Several methods of endoscopic ablation of esophageal lesions have been developed for the resection of superficial tumours of the oesophagus. We report a prospective single centre experience using endoscopic mucosal resection with the cap method (EMR-C, Inoue 1993) and compare outcome in low (lesion type I, IIa, IIb ≤20 mm or IIc ≤ 10 mm, stage m or Tis, well or moderately differentiated) versus high risk patients classified pre-operatively according to Ell et al (2000). Patients and Methods: 67 consecutive malignant oesophageal tumors of oesophagus, staged as T1 m1-m2-sm1-sm2, N0 by conventional endosonography (radial or linear array echoendoscope EG-3630-UR or EG-3830-UT, connected to a Hitachi EUB6500) and 20 Mhz miniprobes, were treated with EMR-C after submucosal saline injection. APC was performed if necessary for remnant bridges or peripheral islets. 31 patients were classified as low risk group (group 1) and 26 as high risk (group 2). The lesions were spinocellular carcinoma, adenocarcinoma and high grade dysplasia in Barrett's esophagus in 17, 20 and 20 patients, respectively. Results: 228 EMR-C specimens were removed in 57 patients (mean age 71 y, range 47-88, sex ratio 38M/19F), in 1.3 (1-2) treatment sessions per patient in group 1 and 1.2 sessions (1-3) in group 2, with a mean of 3.3 EMR-C pieces per mucosectomy (1-15). Follow-up was similar in group 1 (16.6 months, 2-47) and 2 (11.5, 2-39). Group 1 significantly differed from group 2 when considering recurrence during follow up (0% vs 42.7%, P< 0.05), regardless of histological type of tumour. Complications occurred in 0.09% of sessions and were limited to 6 esophageal strictures requiring 1-3 endoscopic dilatations. During follow-up 3 patients died of various diseases not related to their oesophageal cancer. Seven patients in group 2 were further referred for surgical resection or complementary chemoradiotherapy. Conclusions: EMR-C is a highly effective and safe method of endoscopic treatment for superficial malignant oesophageal tumors classified as low risk. Outcome after EMR-C depends on proper staging of patients before treatment, but the pathology specimen obtained by EMR also allowed adequate patients' selection for further surgery or radiochemotherapy.