Background: Curative endoscopic therapy for esophageal neoplasia is generally not possible in the U.S. because the diagnosis is rarely made at an early stage. However screening high risk populations in China with balloon cytology identifies a group of pts in whom curative Rx may be possible. As part of an ongoing project between the national cancer institutes in the U.S. and China, such pts have been identified. Methods: In May 1995, 439 asymptomatic Linxian adults were screened for ED/EEC by endoscopy. Pts with advanced cancer were offered surgery but pts with ED (MD=moderate dysplasia; SD=severe dysplasia) or EEC who were not operated, were seen in follow-up in Sept 1996 and offered endo RX if endoscopic findings, or in some cases EUS, suggested curable treatment may be possible. For small, localized lesions (<3 cm), endoscopie mucosal resection (EMR) was performed with the Makuuchi overtube and snare resection (EMR-MT) or by lift and cut (L/C) technique. For diffuse lesions (>3cm) or if multiple lesions existed, pts were treated with coagulation, usually argon plasma coagulation (APC). Results: 42 pts (24 M; 18 F) ranging in age from 41 to 70 years (mean 63.4) were treated (see table). Severe arterial bleeding requiring APC occurred after EMR in 1 pt. Results of f/u endoscopy and biopsy at 6 wks will also be presented. Initial Histologic Diagnosis Endoscopic RX MP SD EEC Total APC only 19 8 1 28 EMR only EEMR-Mt 34 7 L/C 1 1 2 EMR + APC 3 2 5 Conclusions: (1) Cytologic screening in high risk groups identifies asymptomatic pts with early esophageal neoplasia who are amenable for endo Rx (2) EMR and APC are feasible with acceptable complx rates (3) these techniques should be applied in high risk populations in the U.S.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging