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Endoscopic mucosal resection for early esophageal carcinoma is effective and safe but necessitates continued surveillance

Indian Journal of Gastroenterology volume 39, pages 487–494 (2020)Cite this article

Abstract

Background

Endoscopic mucosal resection (EMR) is used for the treatment of early esophageal cancer (EEC).

Methods

This a retrospective study aimed to study the efficacy, safety, and the recurrence rate of EEC following EMR.

Results

Seventy-nine patients who had undergone EMR for early EEC (T1a andT1b lesions) from 2006 to 2015 were included. EMR alone was considered curative in 51 patients who had T1a lesion. Complete remission was achieved in 50 (98%) patients. Mean number of sessions of EMR was 1.14. Cancer recurred locally in 6 (12%) of 50 patients at a median follow-up of 48 (18-72) months. Endoscopic treatment alone achieved complete remission at last follow up in 47 of 50 patients (94%) who had initial EMR with complete remission, or in 47 of all 51 patients (92%) in whom EMR was considered curative for EC. The Kaplan-Meier cancer-free survival following complete remission with EMR was 94.2% at 1 year and 88.4% at 5 years. Patients with complete eradication of Barrett’s had lower risk of recurrence of adenocarcinoma (AC) compared with patients who had persistent Barrett’s (p = 0.01). EMR alone was not considered curative in 19 patients, 16 with T1b AC and 3 with T1a squamous cell carcinoma (SCC) invading the muscularis mucosa (m3). Two major adverse events were noted: delayed bleeding requiring hospitalization, and perforation that was closed endoscopically.

Conclusion

EMR is effective and safe for the management of early EC. The risk of cancer recurrence, albeit small, warrants surveillance. Complete eradication of Barrett’s should be attempted in all patients after EMR of AC.

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Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, USA

    Y. Hasan, A. R. Murali & H. Gerke

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  1. Y. Hasan
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  2. A. R. Murali
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  3. H. Gerke
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Correspondence to Y. Hasan.

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YH, ARM, and HG declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

The study was approved by the institutional Review Committee, and the study met the guidelines of our institutional review board.

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Hasan, Y., Murali, A.R. & Gerke, H. Endoscopic mucosal resection for early esophageal carcinoma is effective and safe but necessitates continued surveillance. Indian J Gastroenterol 39, 487–494 (2020). https://doi.org/10.1007/s12664-020-01084-1

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  • DOI: https://doi.org/10.1007/s12664-020-01084-1

Keywords

  • Barrett’s esophagus
  • Buried Barrett’s glands
  • Endoscopic mucosal resection
  • Endoscopic sumucosal dissection
  • Esophagus
  • Gastroesophageal reflux disease
  • Recurrence of esophageal carcinoma
  • Squamous cell cancer
  • Surveillance