Endoscopic Diagnosis And Therapy For Esophageal Superficial Elevated-type Lesions

Objective To explore the valuation of the endoscopic diagnosis and therapy for esophagus superficial elevated-type lesions.Methods 37 superficial elevated-type lesions of esophagus from 30 patients were treated by endoscopic therapy from April 2007 to December 2009 in our hospital. Among the 30 patients, there were 19 men and 11 women(male to female ratio was 1.7:1), and the age was from 38 to 66 years old(the average age was 51.2±8.6). After comprehensive assessed by ordinary endoscopy, chromoendoscopy(CE), endoscopic ultrasonography(EUS) and preoperative biopsy examination, the 37 lesions were in the lines with endoscopic muscosal resection (EMR) and endoscopic submucosal dissections(ESD) indications. The 32 lesions were treated by EMR and the other 5 lesions were treated by ESD. To keeping the vision clear, we used epinephrine saline irrigation, hot biopsy forceps, APC and peeling knives to stop bleeding in timely. After excision, we used APC to treat the wound surfaces and the exposed blood vessels if necessary. After EMR and ESD, the specimens were examined by pathology. The cancer specimens were all continuously sliced and all the section were examined by pathology. All the specimens that excised from muscularis mucosa were examined by routine pathological examination and immunohistochemical test. All the patients were trested with fasting, fluid infusion, restraining acid secretion and antibiotics for 3 days. The patients were gave decompression if their wound surfaces were big. The endoscopy was performed to evaluate the status of wound surfaces, lesions residual and recurrence.Results All of the 37 lesions were examined by ordinary endoscopy, and 32 of them were examined by EUS,18 of them were examined by CE. There were 32 lesions from 25 patients treated by EMR, and among these lesions,13 were treated by strip biopsy,18 lesions by cap EMR (EMR-C) and 1 lesion by endoscopic piecemeal mucosal resection(EPMR). The other 5 lesions from 5 patients were treated by ESD. One patient had 4 lesions, and was operated through EMR by 4. Four patients had 2 lesions, and were operated through EMR by 2. The location of these lesions:four lesions located at upper esophagus,23 lesions located at middle esophagus,8 lesions located at lower esophagus and 2 lesions spanned middle and lower esophagus. The mean lesion size of EMR was 1.74±0.41cm(0.8-2.5cm) and mean lesion size of ESD was 2.96±0.59cm(2.2-3.6cm).The source level:there were 22 lesions located at mucosa,14 lesions located at muscularis mucosa and 1lesions located at submucosa. The pathologic type:early esophageal cancer 7 lesions, severe dysplasia 9 lesions, moderate dysplasia 2 lesions, adenomatous polyp 1 lesions, noadenomatous polyp 2 lesions, leukoplakia 1 lesions, leiomyoma 14 lesions and congenital cyst 1 lesion. The mean operation time of EMR was 20.0±4.8min(15-30min) and the mean operation time of ESD was 90.0±7.9min(80-100min). All the lesions were completely excised, and there was no residual. Non of the 30 patients occurred massive bleeding during and after operation. There were 8 lesions those operated by EMR and 2 operated by ESD occurred a little of bleeding. And all of them were successfully stopped by endoscopic treatments. One patient occurred perforation during ESD, then we aspirated the air in esophagus in timely and used endoclips to close the wound. After operation,the patient were given active medical treatment for 3 days, such as fasting, fluid infusion, peritoneocentesis, gastrointestinal decompression, antibiotics treatment, absorption of oxygen and so on. The mean hospitalization time of EMR was 4.9±1.6d (3～10d) and the mean hospitalization time of ESD was 7.0±3.2d (3-12d). All the wound surfaces healed completely at 3 months post-operation. In accordance with the different follow-up system of benign and malignant lesions, no lesion recurs.Conclusion Ordinary endoscopy combines chromoendoscopy and endoscopic ultrasonography can accurately determine the nature, source as well as lymph node metastasis of the diseases. These can provide a reliable basis for the development of appropriate therapeutic measures and to determine the scope of endoscopic resection. EMR and ESD are minimally invasive, safe, effective, fast and economy for treating of early esophageal cancer, precancerous lesions, submucosal tumors, sessile polyps and other lesions.