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Endoscopic mucosal resection for staging and treatment of early esophageal carcinoma: a single institution experience

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Abstract

Background

Endoscopic mucosal resection (EMR) has emerged for evaluation and treatment of esophageal nodules. We report our initial experience with EMR for T staging and management of early esophageal cancer.

Methods

We reviewed patients undergoing EMR for esophageal adenocarcinoma between 2008 and 2013. The primary outcome measure was needed for esophagectomy. Secondary outcomes included complete eradication of adenocarcinoma, recurrence or persistence of cancer, nodal status for those undergoing esophagectomy, and complications of endoscopic treatment.

Results

During the study period, 24 patients underwent EMR demonstrating carcinoma, and a grossly margin negative endoscopic resection was achieved in all cases. Ten patients (42 %) had evidence of submucosal invasion and were referred for esophagectomy. Patients with margin negative EMR (n = 10, 42 %) or positive radial margins (n = 4, 16 %) underwent endoscopic surveillance and treatment with radiofrequency ablation or repeat EMR as needed. Thirteen patients (93 %) with intramucosal cancer (IMC) have been successfully managed with ongoing endoscopic surveillance and treatment with a median follow-up of 15.5 months. One patient underwent esophagectomy due to recurrent IMC in the setting of long-segment multifocal high-grade dysplasia. There were no esophageal perforations, one patient developed a self-limited gastrointestinal hemorrhage following EMR, and one had an esophageal stricture following endoscopic management.

Conclusions

IMC can be successfully managed endoscopically and thus esophagectomy is avoided in a significant proportion of patients. Endoscopic management may be utilized in the setting of complete resection or radial margin involvement without evidence of submucosal invasion. Close endoscopic follow-up is of paramount importance even in those with negative margins, because recurrent disease may occur following EMR in these patients.

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Acknowledgments

The authors would like to thank Rebecca Dettorre, MA, CCRC, Research Coordinator for the Center for Minimally Invasive Surgery, for her assistance with this project.

Disclosures

Drs. Huntington, Walker, Meara, Hazey, Melvin, and Perry report no biomedical financial interests or potential conflicts of interest relevant to the subject matter of this manuscript.

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Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, 43210, USA

    Justin T. Huntington, Michael P. Meara, Jeffrey W. Hazey, W. Scott Melvin & Kyle A. Perry

  2. Division of Gastroenterology, The Ohio State University, Columbus, OH, USA

    Jon P. Walker

  3. The Ohio State University Medical Center, 410 W. 10th Avenue, N729 Doan Hall, Columbus, OH, 43210, USA

    Kyle A. Perry

Authors
  1. Justin T. Huntington
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  2. Jon P. Walker
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  3. Michael P. Meara
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  4. Jeffrey W. Hazey
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  5. W. Scott Melvin
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  6. Kyle A. Perry
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Corresponding author

Correspondence to Justin T. Huntington.

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Huntington, J.T., Walker, J.P., Meara, M.P. et al. Endoscopic mucosal resection for staging and treatment of early esophageal carcinoma: a single institution experience. Surg Endosc 29, 2121–2125 (2015). https://doi.org/10.1007/s00464-014-3962-3

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  • DOI: https://doi.org/10.1007/s00464-014-3962-3

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