Original articleAlimentary tractEfficacy, Safety, and Long-term Results of Endoscopic Treatment for Early Stage Adenocarcinoma of the Esophagus With Low-risk sm1 Invasion
Section snippets
Patients
From September 1996–December 2010, a total of 1718 patients with suspected EAC were referred to our department. The patients were included in the department's prospective early carcinoma database. In 123 of these patients (104 men, 85%; 19 women, 15%; mean age, 64 ± 10 years), there was a suspected diagnosis (endoscopic ultrasonography [EUS]), or a diagnosis histologically confirmed at ER or from the surgical specimen, of EAC with incipient submucosal invasion (pT1b sm1) (Figure 1). Sixty-six
Complete Endoluminal Remission
The characteristics of the overall group of 66 patients are shown in Table 1. CER was evaluated in 61 of 66 patients included. One patient was still receiving ET at the time of analysis (1.5%). Four patients were lost to FU (6.1%).
Fifty-three of 61 patients (86.9%) achieved CER. A mean of 2.6 ± 2.9 ERs were needed to reach CER (range, 1–4). The mean treatment period was 4.5 ± 5.3 months (1–23 months). CER was not achieved in 8 patients (13.1%; Table 2).
CER was achieved in 97% of patients with
Discussion
During the last decade, ET for mucosal (pT1a) EAC has gained increasing international acceptance1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 as a curative form of treatment, and it was included in national and international guidelines.28, 33, 34
To the present, the gold standard for the treatment of submucosal (pT1b) EAC has been esophageal resection with LN dissection.25, 26, 35 However, surgical series15, 16 were able to show that no LN metastases were found to occur in lesions limited to the upper third
Acknowledgments
This study formed the basis for Yvonne Heldmann's doctoral thesis at the University of Mainz, Germany.
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This article has an accompanying continuing medical education activity on page e45. Learning Objectives—At the end of this activity, the successful learner will be able to identify lesions that are candidates for endoscopic treatment with a curative intent, and to differentiate between lesions that are candidates for a curative endoscopic treatment approach and lesions that are not.
Conflicts of interest The authors disclose no conflicts.