The Relationship Between The Classification Of Early Esophageal Carcinoma And The TNF,and The Clinical Analysis Of Endoscopic Sequential Therapy For Esophageal Anastomotic Stricture

Background and Objectives:The diagnosis about the early esophageal squamous cell carcinoma is focus on theendoscopic classification and the TNM stage till the present moment. And the T stage isrecognised as the independent factors witch affected the prognosis. At the same time, theendoscopic classification was closely related to the T stage. But recent studies showed that,not only the T stage, but also the TNF, the rate of lymph node metastasis and the rate of thevascular infiltration can influence the prognosis of tumor. The TNF was regarded as theindependent factor of the prognosis of the esophageal carcinoma, gastric carcinoma, coloncarcinoma and gallbladder carcinoma. But until now,there was no studies about therelationship between the endoscopic classification and TNF. Out study is the first time toresearch the connection between the endoscopic classification and TNF, in order to providea basis for the judgment of TNF， TNM and prognosis depend on the endoscopicclassification.The high incidence of anastomotic stenosis after esophageal cancer operative witch ledto dysphagia can seriously affects the patient’s quality of life. We can use balloon dilatation,electrocautery therapy and stent implantation treatment under the endoscopy to solve thisproblem. None of these therapeutic schedules can perfectly solve all kinds of anastomoticstenosis independently. Depend on this problem,we put forward5kinds of programs, thoseare balloon dilatation, electrocautery therapy, balloon combined electrocautery therapy,balloon dilatation combined stent implantation treatment, electrocautery and balloondilatation combined stent implantation treatment. And we also analyzed the indications andefficacy, to provide the basis for the choice of clinical treatment. Methods:1、Restrospectively analyze the relationship among the endoscopic classification, Tstage and INF in our hospital from January2003to June2012. All of the cases accepted thesurgery or endoscopic resection of esophageal cancer, and the pathological results aresuperficial esophageal squamous cell carcinoma.2.Restrospectively analyze the treatment period,the total treatment time and thefrequency of treatment of104cases, who suffered from esophageal anastomotic strictureand accepted different endoscopic treatment options(balloon dilatation, electrocauterytherapy, balloon combined electrocautery therapy, balloon dilatation combined stentimplantation treatment, electrocautery and balloon dilatation combined stent implantationtreatment) in our hospital from January2008to June2013Results:1. All of the Tis are INFa, most of the intramucosal carcinoma (except Tis) andsubmucosal carcinoma are INFb (67.3%and63.41%). But relative to the Tis andintramucosal carcinoma, the submucosal carcinoma takes more INFc(26.83%). So we cansay, different T stage have different INF(P＜0.05).2. Endoscopic classification I according to the Japanese Society for EsophagealDiseases which be used as criteria for the endoscopic classification of early esophagealcancer，the tumor infiltrative pattern classification from INFa to INFc was superficialtype,mixed type and polypoid type,excavated type. But there was no difference betweenmuscularis mucosae and submucosal carcinoma when the tumor infiltrate into them.3. Endoscopic classification II was previously proposed by the authors of this paper ascriteria for the endoscopic classification of early-stage esophageal cancer,the tumorinfiltrative pattern classification from INFa to INFc was surface-propagating growth type,intraluminal growth type and intramural growth type,mixed growth type,bilateral growthtype. And when the tumor infiltrate into the muscularis mucosae and submucosal, therewere obviously difference between surface-propagating growth type and bilateral growthtype,surface-propagating growth type and intramural growth type, surface-propagatinggrowth type and mixed growth type.4. There were obviously difference between balloon dilatation and electrocautery therapy, balloon dilatation and balloon combined electrocautery therapy, balloon dilatationand electrocautery therapy, balloon dilatation combined stent implantation treatment whenwe analysed the number of treatment to get complete remission(P＜0.05). And there wereobviously difference between electrocautery therapy and balloon dilatation andelectrocautery therapy, electrocautery therapy and balloon dilatation combined stentimplantation treatment, balloon dilatation and electrocautery therapy, balloon dilatationcombined stent implantation treatment when we analysed the interphase of treatment (P＜0.05). Also there were obviously difference between electrocautery therapy and balloondilatation combined stent implantation treatment, electrocautery therapy combined balloondilatation treatment and balloon dilatation combined stent implantation treatment when weanalysed the treatment cycle to get complete remission(P＜0.05).Conclusion:1. Both of the endoscopic classification related to the tumor infiltrative pattern.2. Compared with endoscopic classification I, the endoscopic classification II canjudge the growth pattern and the tumor infiltrative pattern of early-stage esophageal cancerbetter.3. Depend on the place, diameter of the stricture of esophageal anastomotic, and theindication for each therapeutic schedule, we can use balloon dilatation, electrocauterytherapy, balloon combined electrocautery therapy, balloon dilatation combined stentimplantation treatment, electrocautery and balloon dilatation combined stent implantationtreatment. Not only can play their respective advantages, but laso can relax the dysphagiaof the patients, reduce the occurrence of complications.