Squamous Cell Dysplasia of the Esophagus ― Studies on Endoscopic Findings and Clinical Management Kumiko Momma 1 , Misao Yoshida 2 , Junko Fujiwara 1 , Takeo Arakawa 1 , Takashi Fujiwara 3 , Hideto Egashira 3 , Naoto Egawa 3 , Akinori Miura 4 , Tsuyoshi Kato 4 , Yousuke Izumi 4 , Tetsuo Nemoto 5 , Nobuaki Funada 5 , Tomoko Hanashi 6 1Department of Endoscopy, Tokyo Metropolitan Komagome Hospital, Tokyo 2Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo 3Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 4Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo 5Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo 6Department of Surgery, Tokai University Tokyo Hospital, Tokyo Keyword: 食道dysplasia , 食道早期癌 , ヨード不染 , 狭帯域内視鏡システム , narrow band imaging , NBI pp.147-159
Published Date 2007/2/25
DOI https://doi.org/10.11477/mf.1403100945
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 Fifteen patients with sixteen esophageal squamous cell dysplasias were included in this study. All patients underwent endoscopic mucosal resection (EMR). Pathological studies on resected specimens revealed neoplastic changes confined to the epithelium with well defined margins. Their grades of cell atypia and structural atypia were less marked in comparison with squamous cell carcinoma. Endoscopic findings allowed us to classify them into three groups : 1) mucosal changes with slight elevation (type 0-IIa-like lesion), 2) flat lesions without any elevation or depression (type 0-IIb-like lesion) and 3) mucosal changes with slight depression (type 0-IIc-like lesion). 1) Type 0-IIa-like lesions included whitish lesions (6) and reddish lesions (1). They showed minimum elevation associated with fine granular changes. They were stained very weakly by iodine staining. Dark brown spots were also noted in some lesion. 2) All type 0-IIb-like lesions (6 lesions) were regarde as iodine-negative lesions. They had irregular shapes and showed very weak staining with iodine. At the same time, dark brown spots were also noted in three cases. In two cases, histological findings were insufficient for differentiation of the cell atypias as neoplastic changes on inflammatory changes. 3) Type 0-IIc-like lesions (two cases) were noted as slightly depressed mucosal changes with slight reddening. Magnifying observation with narrow band imaging (NBI) revealed that type 0-IIc-like dysplasia lesions could be recognized as a mucosal change with slightly brown color. At the same time, low density of intrapapillary capillary loops were also noted. It is recommended as clinical managements of esophageal dysplasia that a dysplasia strongly suggestive of mucosal cancer especially if over 10 mm in size should be treated by EMR followed by histological studies on the resected specimen. Repeated endoscopic surveillance with intervals from three to six months is recommended when endoscopic findings are not strongly suggestive of cancer. Endoscopic observations assisted by magnifying endoscopy and NBI will be helpful for precise evaluation.

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