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Endoscopic resection of early oesophageal cancer
  1. Oliver Pech,
  2. Andrea May,
  3. Thomas Rabenstein,
  4. Christian Ell
  1. 1
    Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany
  1. Professor C Ell, MD, Department of Internal Medicine 2, HSK Wiesbaden, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany; ell.hsk-wiesbaden{at}

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Endoscopic resection (ER) of early neoplastic lesions has become increasingly important in recent years, both as a diagnostic tool for the staging of oesophageal carcinomas and as a method of carrying out definitive treatment when the cancer meets certain criteria in which the risk of lymph-node metastasis is negligible. Early diagnosis, especially of neoplastic lesions arising in Barrett’s oesophagus, has become more frequent as a result of improved endoscopic technology, surveillance programmes, and increasing experience and awareness on the part of endoscopists. For many years, surgery was considered to be the treatment of choice, even in patients with high-grade intraepithelial neoplasia (HGIN) or mucosal carcinoma, but it is associated with a 30-day mortality of between 3 and 10% and with significant morbidity in 40–50% of cases.1 2 In low-volume centres or with less experienced surgeons, the mortality rate with radical oesophageal resection can rise to more than 20%.3 4

These alarming data are the reason why local treatment methods such as photodynamic therapy (PDT), argon plasma coagulation (APC), electrocoagulation and ER have been introduced and investigated in several studies on early oesophageal neoplasia. In contrast to ablative treatment methods such as PDT, ER allows histological assessment of the resected specimen in order to assess the depth of infiltration of the tumour and freedom from neoplasia at the lateral and (more importantly) basal margins, imitating the surgical situation.5 These significant advantages of ER are the main reason why ER should be preferred to ablative treatment methods, even PDT, whenever possible, especially bearing in mind the low accuracy of endoscopic ultrasound (EUS) regarding local tumour staging.611 Arguments in favour of ER are listed in table 1.

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Table 1 Points in favour of endoscopic resection of early oesophageal carcinoma


‘Endoscopic resection’ is the general term for all of the different resection techniques used to treat neoplastic and uncertain …

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