Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, USA.
Indian J Gastroenterol. 2020 Oct;39(5):487-494. doi: 10.1007/s12664-020-01084-1. Epub 2020 Nov 17.
Endoscopic mucosal resection (EMR) is used for the treatment of early esophageal cancer (EEC).
This a retrospective study aimed to study the efficacy, safety, and the recurrence rate of EEC following EMR.
Seventy-nine patients who had undergone EMR for early EEC (T1a andT1b lesions) from 2006 to 2015 were included. EMR alone was considered curative in 51 patients who had T1a lesion. Complete remission was achieved in 50 (98%) patients. Mean number of sessions of EMR was 1.14. Cancer recurred locally in 6 (12%) of 50 patients at a median follow-up of 48 (18-72) months. Endoscopic treatment alone achieved complete remission at last follow up in 47 of 50 patients (94%) who had initial EMR with complete remission, or in 47 of all 51 patients (92%) in whom EMR was considered curative for EC. The Kaplan-Meier cancer-free survival following complete remission with EMR was 94.2% at 1 year and 88.4% at 5 years. Patients with complete eradication of Barrett's had lower risk of recurrence of adenocarcinoma (AC) compared with patients who had persistent Barrett's (p = 0.01). EMR alone was not considered curative in 19 patients, 16 with T1b AC and 3 with T1a squamous cell carcinoma (SCC) invading the muscularis mucosa (m3). Two major adverse events were noted: delayed bleeding requiring hospitalization, and perforation that was closed endoscopically.
EMR is effective and safe for the management of early EC. The risk of cancer recurrence, albeit small, warrants surveillance. Complete eradication of Barrett's should be attempted in all patients after EMR of AC.
内镜黏膜切除术（EMR）用于治疗早期食管癌（EEC）。
这是一项回顾性研究，旨在研究 EMR 治疗早期 EEC 的疗效、安全性和复发率。
2006 年至 2015 年期间，79 例早期 EEC（T1a 和 T1b 病变）患者接受了 EMR 治疗。51 例 T1a 病变患者的 EMR 单独治疗被认为是治愈性的。50 例（98%）患者完全缓解。EMR 的平均治疗次数为 1.14 次。在中位随访 48（18-72）个月时，50 例完全缓解的患者中有 6 例（12%）局部复发。在最初 EMR 完全缓解的 50 例患者中的 47 例（94%）或在所有 51 例 EMR 被认为可治愈的 EC 患者中的 47 例中，单独进行内镜治疗最终完全缓解。EMR 完全缓解后的无癌生存率在 1 年时为 94.2%，在 5 年时为 88.4%。与 Barrett 持续存在的患者相比，Barrett 完全消除的患者腺癌（AC）复发的风险较低（p = 0.01）。19 例患者 EMR 单独治疗不能治愈，其中 16 例为 T1b AC，3 例为 T1a 鳞状细胞癌（SCC）侵犯黏膜肌层（m3）。注意到 2 例主要不良事件：需要住院治疗的延迟性出血和内镜下闭合的穿孔。
EMR 是治疗早期 EC 的有效且安全的方法。尽管复发风险很小，但仍需要进行监测。在 AC 的 EMR 后，应尝试在所有患者中彻底消除 Barrett。
