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Published in: Surgical Endoscopy 2/2011

01-02-2011

Endoscopic mucosal resection for gastroesophageal cancer in a U.K. population. Long-term follow-up of a consecutive series

Authors: Andrew B. C. Crumley, James J. Going, Kerryanne McEwan, Margaret McKernan, Jo-Etienne Abela, Christopher J. Shearer, Adrian J. Stanley, Robert C. Stuart

Published in: Surgical Endoscopy | Issue 2/2011

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Abstract

Background

Endoscopic mucosal resection (EMR) of early gastric and esophageal tumors is effective and avoids the morbidity and mortality of surgery. We report the long-term results of a consecutive series of 93 endoscopic resections, during a 7-year period, in a U.K. population.

Methods

Eighty-eight patients with 93 lesions were included. EMR was performed for 64 and 29 malignant and benign lesions, respectively. Patients with malignant disease were subgrouped into “high risk” or “low risk” for recurrence.

Results

Of the 35 lesions in the low-risk group, local control was achieved in 31; 29 after 1 EMR session. Two had residual invasive carcinoma, one had treatment ceased due to pancreatic cancer, and one patient did not attend follow-up. Of the 29 lesions in the high-risk group, local control was achieved in 15; 13 after 1 EMR session. Median follow-up was 53 months. Cancer specific survival for the 45 invasive cancers (T1m and T1sm) was 93%; three patients died from their disease.

Conclusions

This study has shown for the first time in a U.K. population that EMR is effective in controlling disease in patients with local high grade dysplasia (HGD) and early invasive carcinoma, with no mortality and low morbidity.
Literature
2.
go back to reference Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMed Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMed
3.
go back to reference Takeshita K, Tani M, Inoue H, Saeki I, Hayashi S, Honda T, Kando F, Saito N, Endo M (1997) Endoscopic treatment of early oesophageal or gastric cancer. Gut 40:123–127PubMed Takeshita K, Tani M, Inoue H, Saeki I, Hayashi S, Honda T, Kando F, Saito N, Endo M (1997) Endoscopic treatment of early oesophageal or gastric cancer. Gut 40:123–127PubMed
4.
go back to reference Ell C, May A, Gossner L, Pech O, Gunter E, Mayer G, Henrich R, Vieth M, Muller H, Seitz G, Stolte M (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118:670–677CrossRefPubMed Ell C, May A, Gossner L, Pech O, Gunter E, Mayer G, Henrich R, Vieth M, Muller H, Seitz G, Stolte M (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118:670–677CrossRefPubMed
5.
go back to reference Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10CrossRefPubMed Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10CrossRefPubMed
6.
go back to reference Conio M, Repici A, Cestari R, Blanchi S, Lapertosa G, Missale G, Della CD, Villanacci V, Calandri PG, Filiberti R (2005) Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett’s esophagus: an Italian experience. World J Gastroenterol 11:6650–6655PubMed Conio M, Repici A, Cestari R, Blanchi S, Lapertosa G, Missale G, Della CD, Villanacci V, Calandri PG, Filiberti R (2005) Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett’s esophagus: an Italian experience. World J Gastroenterol 11:6650–6655PubMed
7.
go back to reference Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206 (Epub 2008 May 6)CrossRefPubMed Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206 (Epub 2008 May 6)CrossRefPubMed
8.
go back to reference Larghi A, Lightdale CJ, Ross AS, Fedi P, Hart J, Rotterdam H, Noffsinger A, Memeo L, Bhagat G, Waxman I (2007) Long-term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy 39(12):1086–1091 (Epub 2007 Aug 15)CrossRefPubMed Larghi A, Lightdale CJ, Ross AS, Fedi P, Hart J, Rotterdam H, Noffsinger A, Memeo L, Bhagat G, Waxman I (2007) Long-term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy 39(12):1086–1091 (Epub 2007 Aug 15)CrossRefPubMed
9.
go back to reference Lopes CV, Hela M, Pesenti C, Bories E, Caillol F, Monges G, Giovannini M (2007) Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg Endosc 21:820–824CrossRefPubMed Lopes CV, Hela M, Pesenti C, Bories E, Caillol F, Monges G, Giovannini M (2007) Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg Endosc 21:820–824CrossRefPubMed
10.
go back to reference Ahmad NA, Kochman ML, Long WB, Furth EE, Ginsberg GG (2002) Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 55:390–396CrossRefPubMed Ahmad NA, Kochman ML, Long WB, Furth EE, Ginsberg GG (2002) Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 55:390–396CrossRefPubMed
11.
go back to reference Tseng EE, Wu TT, Yeo CJ, Heitmiller RF (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome—an update. J Gastrointest Surg 7:164–170CrossRefPubMed Tseng EE, Wu TT, Yeo CJ, Heitmiller RF (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome—an update. J Gastrointest Surg 7:164–170CrossRefPubMed
12.
go back to reference Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232(6):733–742CrossRefPubMed Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232(6):733–742CrossRefPubMed
13.
go back to reference Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Peters JH, Oberg S, Theisen J, Kiyabu M, Crookes PF, Bremner CG (1999) Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 117(1):16–23CrossRefPubMed Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Peters JH, Oberg S, Theisen J, Kiyabu M, Crookes PF, Bremner CG (1999) Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 117(1):16–23CrossRefPubMed
14.
go back to reference Migliore M, Choong CK, Lim E, Goldsmith KA, Ritchie A, Wells FC (2007) A surgeon’s case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg 32:375–380CrossRefPubMed Migliore M, Choong CK, Lim E, Goldsmith KA, Ritchie A, Wells FC (2007) A surgeon’s case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg 32:375–380CrossRefPubMed
16.
go back to reference Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39(1):58–62CrossRefPubMed Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39(1):58–62CrossRefPubMed
17.
go back to reference Dehyle P, Largiader F, Jenny S (1973) A method for endoscopic electroresection of sessile colonic polyps. Endoscopy 5:38–40CrossRef Dehyle P, Largiader F, Jenny S (1973) A method for endoscopic electroresection of sessile colonic polyps. Endoscopy 5:38–40CrossRef
18.
go back to reference Martin TR, Onstad GR, Silvis SE, Vennes JA (1976) Lift and cut biopsy technique for submucosal sampling. Gastrointest Endosc 23(1):29–30CrossRefPubMed Martin TR, Onstad GR, Silvis SE, Vennes JA (1976) Lift and cut biopsy technique for submucosal sampling. Gastrointest Endosc 23(1):29–30CrossRefPubMed
19.
go back to reference Soehendra N, Binmoeller KF, Bohnacker S, Seitz U, Brand B, Thonke F, Gurakuqi G (1997) Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 29(5):380–383CrossRefPubMed Soehendra N, Binmoeller KF, Bohnacker S, Seitz U, Brand B, Thonke F, Gurakuqi G (1997) Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 29(5):380–383CrossRefPubMed
20.
go back to reference Chaves DM, Sakai P, Mester M, Spinosa SR, Tomishige T, Ishioka S (1994) A new endoscopic technique for the resection of flat polypoid lesions. Gastrointest Endosc 40(2 Pt 1):224–226CrossRefPubMed Chaves DM, Sakai P, Mester M, Spinosa SR, Tomishige T, Ishioka S (1994) A new endoscopic technique for the resection of flat polypoid lesions. Gastrointest Endosc 40(2 Pt 1):224–226CrossRefPubMed
21.
go back to reference Fleischer DE, Wang GQ, Dawsey S, Tio TL, Newsome J, Kidwell J, Prifti S (1996) Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc 44(1):68–72CrossRefPubMed Fleischer DE, Wang GQ, Dawsey S, Tio TL, Newsome J, Kidwell J, Prifti S (1996) Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc 44(1):68–72CrossRefPubMed
22.
go back to reference May A, Gossner L, Behrens A, Kohnen R, Vieth M, Stolte M, Ell C (2003) A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc 58(2):167–175CrossRefPubMed May A, Gossner L, Behrens A, Kohnen R, Vieth M, Stolte M, Ell C (2003) A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc 58(2):167–175CrossRefPubMed
Metadata
Title
Endoscopic mucosal resection for gastroesophageal cancer in a U.K. population. Long-term follow-up of a consecutive series
Authors
Andrew B. C. Crumley
James J. Going
Kerryanne McEwan
Margaret McKernan
Jo-Etienne Abela
Christopher J. Shearer
Adrian J. Stanley
Robert C. Stuart
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 2/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1213-9

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