Endoscopic Treatment of Squamous Cell Carcinoma of the Esophagus─Selection of Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection Kumiko Momma 1 , Misao Yoshida 2 , Junko Fujiwara 1 , Hideto Egashira 3 , Takashi Fujiwara 3 , Takeo Arakawa 1 , Naoto Egawa 1 , Masatake Miyamoto 4 , Akinori Miura 4 , Tsuyoshi Kato 4 , Yousuke Izumi 4 , Yoko Tateishi 5 , Tetsuo Nemoto 5 1Department of Endoscopy, Tokyo Metropolitan Komagome Hospital, Tokyo 2Foundation for Detection of Early Gastric Carcinoma, 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 Keyword: 内視鏡的食道粘膜切除術 , 粘膜下層剥離術 , 早期食道癌 , 一括切除 , 食道扁平上皮癌 pp.325-334
Published Date 2009/3/25
DOI https://doi.org/10.11477/mf.1403101599
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 We studied the indications for endoscopic mucosal resection(EMR), which has a size limitation, and endoscopic submucosal dissection(ESD)for lump resection of esophageal squamous cell carcinoma(SCC)based on investigation of the results in cases that underwent EMR in our hospital. The study population consisted of 106 patients treated by EMR with lump resection for lesions <25 mm in diameter between January 2005 and December 2006. The depths of invasion in these 106 cases were as follows : T1a-EP(n=76),T1a-LPM(10),T1a-MM(14),SM1(2), and SM2(4). The lesion size distribution was as follows : minute carcinoma≦5 mm(n=13), small carcinoma 5 mm to 10 mm(25),10 mm to 15 mm(36),15 mm to 20 mm(21),>20 mm(11). The ratio of lump resection in each size class were as follows : minute carcinoma≦5 mm,100% ; small carcinoma 5 mm to 10 mm,100% ; 10 mm to 15 mm,97% ; 15 mm to 20 mm,83% ; and >20 mm in diameter,78%.

 In endoscopic resection of early squamous cell carcinoma of the esophagus, complete eradication by one-piece resection and precise histological examinations on resected specimen allow us to avoid local recurrence and to provide appropriate adjuvant treatment. In cases with lesions less than 15mm in size,EMR is recommended for frequent one-piece resection and easier manipulation compared to ESD. Although ESD requires difficult manipulation, it should be indicated for lesions over 15mm in size, for it provides frequent one-piece resection than EMR.

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