TY - JOUR
T1 - A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus
AU - Zhang, Yue Ming
AU - Boerwinkel, David F.
AU - Qin, Xiumin
AU - He, Shun
AU - Xue, Liyan
AU - Weusten, Bas L.A.M.
AU - Dawsey, Sanford M.
AU - Fleischer, David E.
AU - Dou, Li Zhou
AU - Liu, Yong
AU - Lu, Ning
AU - Bergman, Jacques J.G.H.M.
AU - Wang, Gui Qi
N1 - Publisher Copyright:
© Georg Thieme Verlag KG Stuttgart · New York.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background and aim: Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band ligator without submucosal lifting. In high-risk areas where ESCC is common and endoscopic expertise is limited, MBM may be a better technique. We aimed to compare MBM to the cap-assisted technique for piecemeal endoscopic resection of esophageal ESCCs. Methods: Patients with mucosal HGIN/ESCC (2-6cm, maximum two-thirds of esophageal circumference) were included. Lesions, delineated by 1.25% Lugol staining, were randomized to MBM or cap-assisted piecemeal resection. Endpoints were procedure time and costs, complete endoscopic resection, adverse events, and absence of HGIN/ESCC at 3-month and 12-month follow-up. Results: Endoscopic resection was performed in 84 patients (59 men, mean age 60) using MBM (n=42) or the endoscopic resection cap (n=42). There were no differences in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, P<0.0001). One perforation, seen after using the endoscopic resection cap, was treated conservatively. Total costs of disposables were lower for MBM (€200 vs. €251, P=0.04). At 3-month and 12-month follow-ups none of the patients had HGIN/ESCC at the resection site. Conclusion: Piecemeal endoscopic resection of esophageal ESCC with MBM is faster and cheaper than with the endoscopic resection cap.Both techniques are highly effective and safe. MBM may have significant advantages over the endoscopic resection cap technique, especially in countries where ESCC is extremely common but limited endoscopic expertise and resources exist. (Netherlands trial register: NTR 3246.).
AB - Background and aim: Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band ligator without submucosal lifting. In high-risk areas where ESCC is common and endoscopic expertise is limited, MBM may be a better technique. We aimed to compare MBM to the cap-assisted technique for piecemeal endoscopic resection of esophageal ESCCs. Methods: Patients with mucosal HGIN/ESCC (2-6cm, maximum two-thirds of esophageal circumference) were included. Lesions, delineated by 1.25% Lugol staining, were randomized to MBM or cap-assisted piecemeal resection. Endpoints were procedure time and costs, complete endoscopic resection, adverse events, and absence of HGIN/ESCC at 3-month and 12-month follow-up. Results: Endoscopic resection was performed in 84 patients (59 men, mean age 60) using MBM (n=42) or the endoscopic resection cap (n=42). There were no differences in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, P<0.0001). One perforation, seen after using the endoscopic resection cap, was treated conservatively. Total costs of disposables were lower for MBM (€200 vs. €251, P=0.04). At 3-month and 12-month follow-ups none of the patients had HGIN/ESCC at the resection site. Conclusion: Piecemeal endoscopic resection of esophageal ESCC with MBM is faster and cheaper than with the endoscopic resection cap.Both techniques are highly effective and safe. MBM may have significant advantages over the endoscopic resection cap technique, especially in countries where ESCC is extremely common but limited endoscopic expertise and resources exist. (Netherlands trial register: NTR 3246.).
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U2 - 10.1055/s-0034-1393358
DO - 10.1055/s-0034-1393358
M3 - Article
C2 - 26545174
AN - SCOPUS:84946762408
SN - 0013-726X
VL - 48
SP - 330
EP - 338
JO - Endoscopy
JF - Endoscopy
IS - 4
ER -