| Part 1 Analysis of risk factors for invasion depth and angiolymphatic invasion for circumferential superficial esophageal squamous cell neoplasmsObjectives The evaluation of invasion depth and angiolymphatic invasion of circumferential superficial esophageal squamous cell neoplasms(CSESCNs)can not only assist endoscopists to make the most appropriate plan for patients before treatment,but also is closely related to the prognosis of patients.At present,there are a variety of endoscopic techniques that can assist endoscopists in judging the invasion depth of CSESCNs,but their accuracy is still poor,and it is not possible to accurately assess whether there is angiolymphatic invasion in CSESCNs before endoscopic treatment.Therefore,this study aims to explore the risk factors of the occurrence of submucosal deep invasion and angiolymphatic invasion of CSESCNs.Methods This study retrospectively analyzed the clinical and pathological data of CSESCNs patients who underwent endoscopic resection in the Department of Endoscopy,Cancer Institute and Hospital,Chinese Academy of Medical Sciences(CICAMS)from November 2013 to October 2021,and analyzed the risk factors of submucosal deep invasion and angiolymphatic invasion in CSESCNs lesions by logistic regression model.Results A total of 116 patients with CSESCNs were included in this study for analysis.85 cases were found to have high-grade intraepithelial neoplasia to superficial submucosal invasion(<200 μ m)(20 cases were found to have high-grade intraepithelial neoplasia),and 31 cases were found to have deep submucosal invasion(≥200 μ m).Besides,17 cases were found to have angiolymphatic invasion.Multivariate logistic regression analysis showed that the history of alcohol consumption(OR=3.090,95%CI:1.165-8.200)and the AB type of intraepithelial papillary capillary loop at the lesion(OR=11.215,95%CI:3.95531.797)were independent factors for the depth of invasion.Smoking history(OR=5.824,95%CI:1.704-19.899)and the presence of avascular area(OR=3.393,95%CI:1.28512.072)were independent factors for angiolymphatic invasion.Conclusions CSESCNs with a history of alcohol consumption and type B2-B3 of the intraepithelial papillary capillary loop at the lesion have a higher risk of deep submucosal invasion.CSESCNs with a history of smoking and the presence of avascular area are more likely to have angiolymphatic invasion.Meanwhile,endoscopic ultrasonography(EUS)and narrowband imaging(NBI)combining magnifying endoscopy(ME)can improve the accuracy of preoperative evaluation of the depth of invasion and angiolymphatic invasion of CSESCNs,which could help endoscopists reasonably grasp the indications of endoscopic treatment.Part 2 Comparison of efficacy of endoscopic submucosal dissection and surgical treatment for circumferential superficial esophageal squamous cell neoplasmsBackground With the continuous development of endoscopic therapy techniques,endoscopic treatment of superficial esophageal squamous cell neoplasms(SESCNs)limited to the mucosal layer or the superficial submucosal layer can achieve a prognostic effect similarly to that of surgery.In recent years,endoscopic submucosal dissection(ESD)has become the preferred treatment for SESCNs.Currently,a large area of SESCNs or even the whole circumferential esophageal lesion can be removed by ESD with good prognosis.However,the applicability of ESD to circumferential superficial esophageal squamous cell neoplasms remains controversial,and there are few studies comparing the short-term and long-term efficacy of ESD versus surgical treatment of CSESCNs.Therefore,this study analyzed retrospectively and compared the efficacy of ESD and surgical treatment of CSESCNs,and evaluated the safety and efficacy of ESD treatment of CSESCNs.Methods The clinical and pathological data of 153 patients with CSESCNs who underwent ESD and surgical treatment in Cancer Hospital of Chinese Academy of Medical Sciences from November 2013 to October 2021 were retrospectively analyzed.The en bloc resection rate(ER),complete resection rate(CR),operation time,postoperative complication rate,postoperative quality of life,postoperative disease recurrence rate and survival rate were analyzed by SPSS statistical software.Results In the ESD group,the ER was 100%and the CR was 96.6%.The longitudinal diameter of the lesion exceeding 50mm was not significantly correlated with bleeding,perforation,postoperative esophageal stricture,submucosal deep invasion(≥200 μm),angiolymphatic invasion,ER and CR(P>0.05).The operation time in ESD group was significantly less than that in surgical group(P<0.001).The EORTC-QLQ-C30 function scores(general health level,emotional function,and cognitive function)in ESD group were significantly better than those in surgical group(P<0.05).The EORTC-QLQ-C30 and EORTC-QLQ-OES18 symptom scores(pain,tachypnea,insomnia,loss of appetite,diarrhea,and reflux)in surgical group were significantly higher than those in ESD group(P<0.05).There was no significant difference in disease recurrence rate and postoperative survival rate between ESD group and surgical group(P>0.05).Not only polyglycolic acid(PGA)combined with autogenous esophageal mucosa(AEM)transplantation and temporary stent implantation(TSI),but also PGA combined with AEM and self-control dilation balloon(SDB)could effectively prevent postoperative stenosis and significantly reduce the number of endoscopic dilations after ESD.Conclusions CSESCNs can be treated with ESD treatment,which is safe.Compared with traditional surgery,it has less trauma and better clinical effect,which greatly improves the postoperative life quality of patients.Esophageal stenosis after ESD can still be cured by proper prevention or endoscopic dilation.ESD can be the first choice of treatment for CSESCNs. |
