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Esophagus

In this topic, endoscopic mucosal resection (abbreviated to EMR hereafter) for early esophageal cancer will be summarized. It has been reported that the incidence of lymph node metastasis is extremely low in patients with early esophageal cancer involving the intramucosal regions only. Therefore, lymph node dissection does not have to be considered in indicating treatment. In patients with typical esophageal squamous cell carcinoma,

  1. the lesion border can be accrately visualized as a non-stained zone by Lugol iodine staining;
  2. EMR, a procedure in which the most superficial mucosal layer is resected together with the submucosal layer, has been established;
  3. it was demonstrated that the treatment response of intramucosal cancer did not differ between surgical esophageal resection and EMR.

For these reasons, EMR is considered the first-choice treatment for esophageal intramucosal cancer.
However, although such cases are rare,

  1. the risk of complications such as perforation, bleeding, mediastinal sinusitis and stenosis; and
  2. the possibilities of recurrence related to residual cancer, lymph node metastasis, remote organ metastasis and metachronal esophageal cancer can't be completely denied.

Therefore, not only skilled endoscopic procedure at a specific level or higher but also extensive knowledge about esophageal cancer and accurate diagnosis are required to perform EMR. Patients with esophageal intramucosal cancer who underwent EMR are presented below.

suggesting intramucosal cancer
£Figure1
An irregurar lesion border can be accrately visualized as a non-stained zone by Lugol iodine staining in the middle esophagus, suggesting intramucosal cancer. On biopsy, histopathological examination revealed typical squamous cell carcinoma. To treat this lesion, EMR was performed.

This is an endoscopic figure of the site 49 days
£Figure2
This is an endoscopic figure of the site 49 days after EMR. There was no marked non-staining zone, although scar remained. Furthermore, biopsy did not detect any residual cancer.