Endoscopic therapy for early esophageal cancer (EEC) and dysplasia (D)

As part of an ongoing project to identify and treat pts with EEC and D in Linxian, a rural county in north, central China, pts were screened with balloon cytology and endoscoped if cytology was abnormal. At endoscopy, the mucosa was sprayed with Lugol's iodine which stains normal (glycogen-containing) squmous epithelium brown but leaves areas of cancer and dysplasia unstained. Pts with localized abnormalities were considered for endoscopic therapy. RESULTS: Balloon cytology was performed on 2043 asymptomatic pts >50 yrs of age. 225 pts (115M;110F) underwent endoscopy. 23 pts were selected for endoscopic therapy if they had localized findings on endoscopy. The intent had been to use endoscopic ultrasonography (EUS) to assist with the selection of pts but technical problems did not allow for the use of EUS in this phase of the study. 23 pts underwent endoscopic therapy by the following methods: 1) coagulation-15; 2) mucosectomy-5; and 3) lift and cut followed by coagulation-3. The histology in the treated pts was as follows: moderate or severe dysplasia-15; carcinoma in-situ-6; squamous carcinoma-1; undefined-1. Mucosectomy was performed by injecting the lesion with saline to raise a bleb. Then a variceal ligator was adapted to the endoscope and a band applied to form a polypoid lesion which was later snared and sent for pathological evaluation. Successful mucosectomy was carried out in all 5 pts. In pt #1, 2 ligation/polypectomies were required. In pt #5, the tissue specimen was not retrieved because of post polypectomy bleeding which required endo rx. Tissue depth was submucosa in 3 and muse mucosa in 1. No other complications occurred in these 5 pts or in the other 18 treated pts. Endoscopic follow-up, which is ongoing, was carried out in all pts to assess adequacy of Rx. CONCLUSIONS: 1) Screening in a high risk population identifies asymptomatic pts with EEC and D. 2) Endoscopy with mucosal spraying identifies a group of pts with localized pathology. 3) Endoscopic therapy should be beneficial in this group of pts. 4) Screening programs which are planned in high risk pts in the United States should consider these methods.