Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanagawa, Japan.
Dig Endosc. 2020 May;32(4):621-627. doi: 10.1111/den.13631. Epub 2020 Mar 20.
Lugol chromoendoscopy is useful for the detection of early esophageal squamous cell cancer (ESCC). Multiple lugol-voiding lesions (LVLs) on lugol chromoendoscopy are associated with a very high risk of multiple cancers arising in the esophagus. Due to the widespread use of narrow band image technology in many institutions, esophageal cancer without LVLs in the background esophagus is sometimes detected. This retrospective study aims to clarify the clinical characteristic of esophageal cancer without LVLs in the background esophagus. A total of 191 consecutive patients with 204 ESCCs had undergone endoscopic submucosal dissection (ESD) from 2011 and 2014. Amongst these lesions, the number of LVLs in the background esophagus per endoscopic view was counted excluding main lesion, and the grading was divided into no LVLs ESCC (nL-ESCC) group and LVLs ESCC (L-ESCC) group. This study evaluated the clinical characteristics and the cumulative incidence of metachronous ESCC after ESD in both groups. Thirty-six patients with 36 lesions and 155 patients with 168 lesions were separated into the nL-ESCC group and L-ESCC group, respectively. On multivariate analysis, the nL-ESCC group was found to be more common in females, who were non-drinkers, or with erosive esophagitis. During follow-up periods, the cumulative incidence of metachronous ESCC at 3-years was 14.4% and 0.00% in the L-ESCC and nL-ESCC groups, respectively (P < 0.01). Our study showed that esophageal cancer without LVLs in the background esophagus was mostly occurred in females, who were non-drinkers, or with erosive esophagitis, which are uncommon features of ESCC.
卢戈氏染色内镜检查有助于发现早期食管鳞状细胞癌（ESCC）。卢戈氏染色内镜下的多发卢戈氏染色缺损（LVLs）与食管多发癌的发生风险极高相关。由于在许多机构广泛使用窄带成像技术，有时会检测到背景食管中无 LVLs 的食管癌。本回顾性研究旨在阐明背景食管中无 LVLs 的食管癌的临床特征。2011 年至 2014 年，共有 191 例连续患者的 204 例 ESCC 接受了内镜黏膜下剥离术（ESD）。在这些病变中，每个内镜视野背景食管中的 LVL 数量（不包括主病灶）进行计数，并将分级分为无 LVLs ESCC（nL-ESCC）组和 LVLs ESCC（L-ESCC）组。本研究评估了两组患者 ESD 后异时性 ESCC 的临床特征和累积发生率。将 36 例 36 个病灶和 155 例 168 个病灶的 36 例患者和 155 例患者分别分为 nL-ESCC 组和 L-ESCC 组。多因素分析发现，nL-ESCC 组女性更为常见，她们是非饮酒者或伴有腐蚀性食管炎。在随访期间，L-ESCC 组和 nL-ESCC 组的异时性 ESCC 累积发生率分别为 3 年时的 14.4%和 0.00%（P < 0.01）。本研究表明，背景食管中无 LVLs 的食管癌多发生于女性，非饮酒者或伴有腐蚀性食管炎，这些是 ESCC 不常见的特征。
