Introduction: Endoscopic diagnosis and therapy with mucosal resection (EMR) and submucosal dissection (ESD) of early esophageal squamous cell carcinoma (SCC) have considerably improved with development of different endoscopic device. It is essential for gastrointestinal endoscopists to detect lesions when they are still endoscopically treatable. Electronic chromoendoscopy, like NBI and i-Scan, help us to detect early squamous neoplasia of the esophagus. Iodine staining can be improved considerably, especially for the high-risk population such as an over 50-year-old male with a history of alcohol and tobacco abuse, the detection of early SCC. Protocols for follow up after EMR or ESD for esophageal squamous cell carcinoma should be based on the risks of lymph-node and distant metastasis as assessed on the basis of tumor staging at initial treatment. Early detection of recurrence or metachronous carcinomas often allows curative or less invasive treatment. Methods: A 54-years old man, with a history of right pyriform sinus neoplasia, was admitted to our unit for endoscopic treatment of an esophageal SCC. Because of a HCV hepatitis the patient underwent in an other endoscopic unit an esophago-gastro-duodenoscopy (EGD), showing, in the distal esophagus, a 5 cm length irregular area, extended for half circumference. In the proximal third of the esophagus a similar area of 20 x 20 mm was diagnosed. Histology diagnosed an early SCC, not involving the submucosal layer, for both lesions. EUS was negative for lymph-nodes involvement and for submucosal layer invasion of both lesions. Results: In our unit, under deep sedation, the patient underwent EGD with double ESD of both synchronous lesions (video). The patient was fed after 2 days and was discharged 4 days after the double ESD. Conclusions: This is a rare case of double early SCC of the esophagus treated with a double ESD in the same endoscopic session. In this rare case a double ESD is a feasible technique only in referral center and expert hands.
Double endoscopic submucosal dissection for synchronous early esophageal squamo-cellular carcinoma (video).
Mangiavillano B;
2015-01-01
Abstract
Introduction: Endoscopic diagnosis and therapy with mucosal resection (EMR) and submucosal dissection (ESD) of early esophageal squamous cell carcinoma (SCC) have considerably improved with development of different endoscopic device. It is essential for gastrointestinal endoscopists to detect lesions when they are still endoscopically treatable. Electronic chromoendoscopy, like NBI and i-Scan, help us to detect early squamous neoplasia of the esophagus. Iodine staining can be improved considerably, especially for the high-risk population such as an over 50-year-old male with a history of alcohol and tobacco abuse, the detection of early SCC. Protocols for follow up after EMR or ESD for esophageal squamous cell carcinoma should be based on the risks of lymph-node and distant metastasis as assessed on the basis of tumor staging at initial treatment. Early detection of recurrence or metachronous carcinomas often allows curative or less invasive treatment. Methods: A 54-years old man, with a history of right pyriform sinus neoplasia, was admitted to our unit for endoscopic treatment of an esophageal SCC. Because of a HCV hepatitis the patient underwent in an other endoscopic unit an esophago-gastro-duodenoscopy (EGD), showing, in the distal esophagus, a 5 cm length irregular area, extended for half circumference. In the proximal third of the esophagus a similar area of 20 x 20 mm was diagnosed. Histology diagnosed an early SCC, not involving the submucosal layer, for both lesions. EUS was negative for lymph-nodes involvement and for submucosal layer invasion of both lesions. Results: In our unit, under deep sedation, the patient underwent EGD with double ESD of both synchronous lesions (video). The patient was fed after 2 days and was discharged 4 days after the double ESD. Conclusions: This is a rare case of double early SCC of the esophagus treated with a double ESD in the same endoscopic session. In this rare case a double ESD is a feasible technique only in referral center and expert hands.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
