Lin Lien-Fu, Huang Pi-Teh, Ho Ka-Sic, Tung Jai-Nien
Division of Gastroenterology, Department of Internal Medicine, Tung's Taichung Metroharbor Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2008 Jul;71(7):347-52. doi: 10.1016/S1726-4901(08)70137-0.
Early esophageal mucosal carcinoma (M1 and M2) can be treated by ablation, or by endoscopic resection such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection. Endoscopic resection enables pathologic examination of resected specimens. We hereby report our experiences with early esophageal cancer and its endoscopically observed types, chromoendoscopy with Lugol's iodine and EMR results.
Between May 2003 and July 2007, 9 patients with early esophageal carcinoma underwent EMR. The diagnosis was made by conventional endoscopy (waiting for the relaxed phase during esophageal peristalsis) followed by chromoendoscopy using 3% Lugol's iodine to stain suspected early lesions or in high-risks patients. Miniprobe endoscopic ultrasound examinations were performed in all cases except 1. EMRs were carried out with a cap-fitted endoscope (EMRC).
There were 6 male and 3 female patients, with a median age of 53 years (range, 44-83 years). Six of the 9 cases had a history of smoking, 5 had a history of drinking, and 4 had a history of betel nut chewing. The endoscopic pictures of the early cancers were type 0-IIa (1 case), type 0-IIb (2 cases), and type 0-IIc (6 cases). One patient had double 0-IIc lesions. Two 0-IIb cases were detected only by chromoendoscopy using Lugol's iodine staining. The median size of the lesions was 0.85 cm (range, 0.7-2.0 cm). The final pathology reports of the endoscopically resected specimens were well-differentiated squamous cell carcinoma with free vertical and lateral margins, and no vascular or lymphatic invasion. The depths of tumor invasion were mucosal layer M1 in 7 cases, M2 in 1 case, and submucosal layer SM1 in the remaining case. There were no perforation or bleeding complications. The mean follow-up period was 13.1 months (range, 4-46 months). A M2 early esophageal cancer measuring 2 cm in diameter recurred 6 months after piecemeal EMRC. No additional adjuvant therapy was given to the SM1 case owing to her old age and bedridden condition.
Early esophageal cancer can be diagnosed by meticulous examination of the esophageal mucosa with conventional endoscopy, facilitated by Lugol's iodine staining, and can be treated by EMR, which is safe. Recurrence can occur after piecemeal EMR.
早期食管黏膜癌（M1和M2）可通过消融治疗，或通过内镜切除，如内镜黏膜切除术（EMR）和内镜黏膜下剥离术。内镜切除能够对切除标本进行病理检查。我们在此报告我们对早期食管癌及其内镜观察类型、卢戈氏碘染色内镜检查和EMR结果的经验。
2003年5月至2007年7月期间，9例早期食管癌患者接受了EMR。诊断通过传统内镜检查（等待食管蠕动的松弛期），随后使用3%卢戈氏碘对疑似早期病变或高危患者进行染色内镜检查。除1例患者外，所有病例均进行了微型探头内镜超声检查。EMR使用带帽内镜（EMRC）进行。
有6例男性和3例女性患者，中位年龄为53岁（范围44 - 83岁）。9例患者中6例有吸烟史，5例有饮酒史，4例有嚼槟榔史。早期癌症的内镜图像为0-IIa型（1例）、0-IIb型（2例）和0-IIc型（6例）。1例患者有两个0-IIc病变。2例0-IIb病例仅通过卢戈氏碘染色内镜检查发现。病变的中位大小为0.85 cm（范围0.7 - 2.0 cm）。内镜切除标本的最终病理报告为高分化鳞状细胞癌，垂直和侧切缘阴性，无血管或淋巴侵犯。肿瘤浸润深度为黏膜层M1 7例、M2 1例，其余1例为黏膜下层SM1。无穿孔或出血并发症。平均随访期为13.1个月（范围4 - 46个月）。1例直径2 cm的M2期早期食管癌在分次EMRC术后6个月复发。由于1例SM1期患者年龄较大且卧床不起，未给予额外的辅助治疗。
早期食管癌可通过传统内镜对食管黏膜进行细致检查，并借助卢戈氏碘染色进行诊断，且可通过安全的EMR进行治疗。分次EMR术后可能会复发。
