Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Mucosa
 The
 Esophagogastric  Junction
 Barrett's
 Esophagus

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OESO©2015
 
Volume: Barrett's Esophagus
Chapter: Screening and surveillance
 

What is the rate of squamous re-epithelialization in Barrett's esophagus following endoscopic mucosal resection?

M. Endo (Tokyo)

Materials and methods

Twelve cases of endoscopic mucosal resection for early adenocarcinoma in Barrett's esophagus were reported in Japan [1-3]. With regard to depth of tumor invasion, mucosal cancer was observed in 9 cases and slightly invasive submucosal cancer was found in 3 cases. Vascular invasion was not observed in any of these cases. In terms of size, 6 lesions were less than 1 cm and all were within 3 cm in size. According to the Japanese macroscopic classification, all lesions were included in the 0-II type, that is, superficial and flat type. 0-IIa slightly elevated type was observed in 4 cases, reddish 0-IIb flat type in 1 case and reddish 0-IIc slightly depressed type in 7 cases.

The procedures of endoscopic mucosal resection was performed in the same way as in squamous cell carcinoma of the esophagus. Although the diagnosis was made by endoscopy and biopsy, it was difficult to recognize the contour of the lesion precisely even when using the staining technique with methylene-blue solution. Prior to endoscopic mucosal resection four marks were placed outside the lesion by electric cautery, however a larger amount of mucosa was generally resected. Piecemeal resection was performed until the target area of the mucosa has been resected. Argon plasma coagulation and laser therapy were also performed additionally when remaining of cancer tissue was suspected based on examination of the resected specimen.

Frequently the lamina propria mucosae, the muscularis mucosae and the submucosa are fibrotically thickened in Barrett's esophagus, therefore the endoscopic mucosal resection required persistence for resection. The injection of physiologic saline solution in the submucosal layer or lifting of the mucosa was not troublesome in any of the cases.

Results

Considering the postoperative complications slight stenosis was encountered in one of these cases. This case was improved easily by balloon dilatation. After endoscopic mucosal resection, proton pump inhibitors and sodium alginate were administered. Squamous reepithelialization of mechanically induced ulcer was observed in 10 cases (83%), columnarlined epithelium in 1 case (8%), and follow-up endoscopic examination was not performed in 1 case (8%). The longest survival period so far was 3 years and a half, with no recurrence, but multiple early adenocarcinoma were observed in 2 cases and endoscopic mucosal resection was repeated.

Summary

- Twelve cases of endoscopic mucosal resection for early adenocarcinoma in Barrett's esophagus were reported in Japan.
- Squamous re-epithelialization was observed in ten cases (83%).
- The total circumferential endoscopic mucosal resection for Barrett's esophagus at the same time has been avoided to protect postoperative stenosis.

References

1. Zeniya A, Ishioka T, Masamune O, et al. Superficial adenocarcinoma arising from Barrett's esophagus, report of a case, Stom Intest 1995;30:1445-1450.

2. Katayama O, Honda H. Endoscopic mucosal resection for superficial adenocarcinoma arising from Barrett's esophagus. Gastroenterol Endosc 1998;40:1598.

3. Hoshihara Y, Yamamoto T, Hashimoto M, et al. An adenocarcinoma in short segment Barrett's esophagus, report of a case. Stom Intest 1999;34:195-198.


Publication date: August 2003 OESO©2015