Endoscopic Mucosectomy for Intraepithelial and Mucosal Cancer of the Esophagus Kumiko Momma 1 , Nobuhiro Sakaki 1 , Tsuyoshi Tajima 2 , Misao Yoshida 3 , Touichirou Takizawa 4 1Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital 2Department of Surgery, Tokyo Metropolitan Komagome Hospital 3Department of Pathology, Tokyo Metropolitan Komagome Hospital Keyword: 内視鏡的食道粘膜切除法 , 食道上皮内癌 , 食道粘膜癌 , 食道異型病変 pp.197-208
Published Date 1991/2/25
DOI https://doi.org/10.11477/mf.1403102462
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 Lymph node metastasis is rare in intraepithelial or mucosal squamous cell carcinoma of the esophagus. An excision of the mucosa including the lesion may be curative for it. Endoscopic mucosectomy technique allows us to remove the mucosa and the submucosa including the lesion preserving the proper muscle layer.We used this technique in precisely predicting the presence of and treating mucosal carcinoma of the esophagus.

 Endoscopic mucosectomy was carried out in 12 cases with esophageal mucosal lesions: tentative diagnosis were intraepithelial cancer in 7 cases, mucosal cancer in 3 and atypical epithelium 2 before the procedure. Lymph node metastasis was not suspected by CT-scan, endoscopic ultrasonography or conventional ultrasonography.

 Results obtained are as follows:  1) Size of the removed mucosa: The largest dimension of the piece of the resected mucosa was approximately 15 mm, indicating that the maximal dimension of a lesion removable by single procedure of resection was approximately 12 mm.

 2) Completeness of resection: A lesion with dimension over 12 mm could be removed by repeating mucosectomy several times. Mucosectomy was done first from the central portion, and then peripheral portion with the surrounding normal mucosa. Endoscopic staining technique using iodine facilitated the procedure. When a lesion was removed without leaving any small islands of cancerous tissue, the procedure was regarded as complete resection. In 11 out of 12 cases resection was regarded as complete and the remaining one incomplete.

 3) No recurrence was observed in cases with complete resection but it occurred in a case with imcomplete resection 6 months later. That case was immediately treated surgically. An intraepithelial carcinoma was found in the resected specimen. Therefore, endoscopic examination was recommended 3, 6, and 12 months after endoscopic mucosectomy for at least one year.

 4) Preoperative diagnoses of mucosal lesion and pathological studies on mucosectomy specimens: Squamous cell carcinoma was detected in 10 cases before the procedure and confirmed by mucosectomy. Intraepithelial carcinoma was not detected until bite biopsy was done before the mucosectomy in 1 case. Degenerated epithelium was wide-spread in the lesion. In 1 of the 2 cases with atypical epithelial lesions, a small focal squamous cell carcinoma was found in the basal layer by endoscopic mucosectomy. Intraepithelial carcinoma was correctly diagnosed in 7 cases before the treatment and mucosal cancer in 3 cases. One of the 2 atypical epithelial cases had intraepithelial carcinoma and the other, atypical epithelial change.

 Thus, it is imperative that we consider on the fact that atypical epithelial lesion of the esophagus is likely to have small carcinoma in it. It is possible to pathologically examine in detail large mucosal pieces obtained by endoscopic mucosectomy. Depth of ivasion of intraepithelial and mucosal carcinoma of the esophagus is correctly and reliably evaluated by conventional endoscopy and bite biopsy. It is feasible to remove the lesion completely by endoscopic mucosectomy. When a single procedure of endoscopic mucosectomy is considered as complete, we may judge it a curative treatment.

Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.


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