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Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)on preoperative invasive depth of early esophageal cancer. Methods A systematic retrieval was performed in PubMed,CNKI and Wangfang databases. Studies on diagnosis of EUS on invasion depth or T1a/T1b stage of early esophageal cancer were retrieved, and related literatures were selected for meta?analysis based on inclusion criteria. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic advantage were calculated,and the receiver operating characteristic curve was drawn to calculate the area under the curve(AUC).Results A total of 20 articles with 1 336 cases were included in the meta?analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC of EUS for T1m staging of early esophageal cancer were 0.86(95%CI: 0.83?0.88), 0.81(95%CI: 0.78?0.85), 4.92(95%CI: 3.02?8.00), 0.19(95%CI: 0.14?0.27), 32.54(95%CI:15.52?68.25)and 0.923,respectively. For T1sm staging, these results were 0.81(95%CI: 0.78?0.85), 0.86(95%CI: 0.83?0.88), 5.17(95%CI: 3.66?7.32), 0.20(95%CI: 0.13?0.33), 32.02(95%CI:15.31?66.99)and 0.922, respectively. Conclusion The diagnostic value of EUS is good for early esophageal cancer, and it has a relatively high sensitivity, specificity and AUC for the T1m and T1sm staging.
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Objective To explore the diagnostic value of pink sign of iodine staining for early esophageal carcinoma. Methods Data of 312 lesions of 306 patients with suspected early esophageal carcinoma who received iodine staining from November 2015 to October 2017 were analyzed retrospectively. Lesions were divided into positive pink sign group and negative pink sign group according to the result of iodine staining. The relationship between pink sign and pathology were analyzed. Lesions recorded onset time of pink sign were divided into 4 groups by the onset time of pink sign, 0-30 s,>30-60 s,>60-90 s and>90-120 s, the diagnostic value of which was assessed with the receiver operating characteristic ( ROC) curve. Results Among the 312 lesions, 208 were identified positive pink sign, including 28 of inflammation or low-grade intraepithelial neoplasia ( LGIN ) , 180 of high-grade intraepithelial neoplasia ( HGIN ) or carcinoma, and 104 lesions were identified negative pink sign, including 69 of inflammation or LGIN, 35 of HGIN or carcinoma. The sensitivity, specificity and accuracy of positive pink sign in the diagnosis of HGIN and early esophageal carcinoma was 83. 7％, 71. 1％ and 79. 8％, respectively. Multivariate analysis showed a significant association between the onset time of pink sign and histopathology ( P=0. 000, OR=0. 016, 95％CI=0. 042-0. 324) . The onset time of pink sign was recorded in 89 lesions in the positive group. The area under ROC curve of the onset time of pink sign was 0. 899, and the optimal cut-off value was 60 s, which indicated the good validity of the test with the sensitivity, specificity and accuracy of 92. 8％, 84. 2％and 91. 0％, respectively. Conclusion The pink sign of iodine staining for diagnosis of early esophageal carcinoma shows a high consistance rate, especially that appears within 60 s.
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Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity, efficacy and safety of ESD in the treatment. Methods From May 2013 to April 2016, 51 consecutive patients underwent high-resolution video endoscopy and biopsy, confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included. There were capillary loops (IPCL), iodine-staining, preoperative and postoperative pathology, and complications to analyze. Results 51 patients had total 58 lesions, Type A, Type B1, Type B2 of IPCL classification were diagnosed in 8 (13.79%), 44 (75.86%), 6 (10.34%). Low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of preoperative biopsy were diagnosed in 11 (18.97%), 42 (72.41%), 5 (8.62%), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of postoperative pathology results were diagnosed in 10 (17.54%), 27 (46.55%), 21 (36.21%), concordance rate of pathological results were 60.34%. Complications included micro-perforations (0.00%), strictures (8.62%) and delayed hemorrhage (3.51%), respectively. Conclusion After endoscopic submucosal dissection, detection rate of early esophageal cancer increased significantly, preoperative biopsy had guidance significance in diagnosis and treatment, ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.
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Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity, efficacy and safety of ESD in the treatment. Methods From May 2013 to April 2016, 51 consecutive patients underwent high-resolution video endoscopy and biopsy, confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included. There were capillary loops (IPCL), iodine-staining, preoperative and postoperative pathology, and complications to analyze. Results 51 patients had total 58 lesions, Type A, Type B1, Type B2 of IPCL classification were diagnosed in 8 (13.79%), 44 (75.86%), 6 (10.34%). Low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of preoperative biopsy were diagnosed in 11 (18.97%), 42 (72.41%), 5 (8.62%), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of postoperative pathology results were diagnosed in 10 (17.54%), 27 (46.55%), 21 (36.21%), concordance rate of pathological results were 60.34%. Complications included micro-perforations (0.00%), strictures (8.62%) and delayed hemorrhage (3.51%), respectively. Conclusion After endoscopic submucosal dissection, detection rate of early esophageal cancer increased significantly, preoperative biopsy had guidance significance in diagnosis and treatment, ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.
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Objective To evaluate the effect and pathological characters for patients with early esophageal carcinoma and intraepithelial neoplasia after endoscopic submucosal dissection (ESD). Methods 69 patients from January 2013 to January 2016 were treated with ESD at the early stage of esophageal carcinoma and intraepithelial neoplasia. The clinical features and the size of the lesions of all the patients were collected. Then analyzed postoperative complications and pathological characteristics. Results Among 69 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The whole piece resection rate was 100.00 % (69/69), complete resection rate and curative resection rate was 95.65 % (66/69), respectively. The largest removal diameter is 7.0 cm. Biopsy accuracy was 69.57 % (48/69). Compared with biopsy, diagnostic accuracy with ESD specimens is higher. Conclusion The early esophageal carcinoma and intraepithelial neoplasia can be treated with ESD. ESD can resect lesions primarily, provide complete specimen for further pathological assessment and improve diagnostic accuracy.
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Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.
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El carcinoma de células escamosas del esófago (CCE) tiene un mal pronóstico debido a que la detección ocurre generalmente en etapas avanzadas. Sin embargo, el desarrollo de la endoscopia de alta resolución con recursos de cromoscopia digital y con lugol ha favorecido el diagnóstico del CCE en estadios iniciales.En paralelo hubo un importante progreso de las técnicas endoscópicas para la resección endoluminal del tumor en bloque, a partir del desarrollo del procedimiento denominado disección endoscópica de la submucosa (DES). Estos avances han permitido la expansión de las indicaciones del tratamiento endoscópico mínimamente invasivo con potencial curativo en pacientes con CCE. El presente artículo de revisión tiene como objetivo principal contribuir a la comprensión de los avances recientes más importantes relacionados al manejo del CCE precoz de esófago. Como objetivo secundario se pretende ofrecer una revisión detallada de la técnica de la DES desarrollada por los expertos japoneses, a fi n de contribuir a la difusión de este concepto y a la incorporación de estas nuevas tecnologías en la endoscopia latinoamericana
Squamous cell carcinoma (SCC) of the esophagus has a poor prognosis because it is generally detected in its advanced stages. Recently however, the development of high resolution endoscopy with digital chromoscopy and Lugol favors diagnosis of SCC in its initial stages. This development was made parallel to development of important endoscopic techniques for endoluminal resectioning of tumors en bloque from endoscopic submucosal dissection (ESD). These advances have increased the indications for minimally invasive endoscopictreatment of SCC of the esophagus providing patients with the potential of a cure. This review article aims to provide an understanding of the most recent and most important advances related to management of early SCC of the esophagus. The secondary objective of this article is to provide a detailed review of the ESD technique developed by Japanese experts. Both objectives have the aim of contributing to the diffusion ofESD and these new technologies to Latin American endoscopy and their incorporation into Latin Americangastroenterological practice.
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Humans , Male , Adult , Female , Young Adult , Carcinoma , Dissection , EsophagusABSTRACT
Objective To evaluate the flexible spectral imaging color enhancement (FICE) system in the diagnosis of early esophageal carcinoma and precancerous lesions.Methods A total of 257 patients with suspicious esophageal lesions were examined successively by FICE,magnifying FICE,iodine dyeing endoscopy and magnifying iodine dyeing endoscopy.Findings were compared with the pathologic diagnosis.Results The positive rates of early esophageal carcinoma by FICE (92.6％,25/27) and iodine dyeing endoscopy (88.9％,24/27) were not significantly different (P =0.642),nor were those of magnifying FICE (96.3％,26/27) and magnifying iodine dyeing endoscopy (92.6％,25/27),(P =0.556).The magnifying FICE could reveal the IPCL of early esophageal carcinoma clearly.Early esophageal carcinoma and advanced neoplasia were mainly type Ⅳ + Ⅴ,low-level neoplasia and esophagitis were type Ⅱ + Ⅲ,and normal esophagus was type Ⅰ.However,the magnifying iodine dyeing endoscopy was not able to reveal IPCL.There was no adverse reaction in FICE,but the adverse reaction rate was 12.8％ (33/257) in iodine dyeing endoscopy.Conclusion Magnifying FICE can accurately determine the pathological types of early esophageal carcinoma,which is an effective complement to iodine dyeing endoscopy.