Submucosal esophagography: a new method for demonstrating the depth of invasion of esophageal cancer.

We developed a new method to determine the depth of esophageal cancer invasion prior to surgery. According to this method, a fiberoptic esophagoscope is used to insert a double cannula into the biopsy canal and the submucosal layer is punctured and fixed by the needle at the tip of the inner cannula through which iodized oil fluid is injected into the submucosal layer. After this procedure, plain films of the posterior mediastinum and an esophagogram are taken in at least four different directions at 24 hour, three and seven day intervals. Seventy one esophageal cancer patients were examined with this method in order to determine the depth of invasion, and whether the adventitia was involved. In three cases the method failed due to technical difficulties and in 14 surgical treatment was not indicated. In 50 of the 54 remaining patients who underwent surgery, preoperative results obtained by using this method coincided well with operative findings. Our findings strongly indicate that this method is diagnostically highly accurate in determining the surgical procedure to be used. Furthermore, this method was proven very useful in obtaining a differential diagnosis of the malignancy of submucosal esophageal tumors,