Abstract

REY FERRO, Mario. Endoscopic treatment of premalignant and malignant lesions in esophagus, stomach, colon and rectum: 150 cases with a follow up of up to 6 years. Rev Col Gastroenterol [online]. 2006, vol.21, n.2, pp.83-90. ISSN 0120-9957.

Objective Comparing 4 endoscopic mucosectomy techniques (EMR) in treating carcinomas and premalign lesions in terms of complete resections, bleeding, perforations, recurrence and survival in the digestive tract. Materials and Methods 150 mucous or submucous lesions were endoscopically analysed in 145 patients having an average age of 59,6 (23-83 years); 28 lesions were in the oesophagus, 79 were gastric, 4 duodenal and 39 colorectal having an average size of 19,3 mms diameter which were resected using plastic cap (68 cases), snare (45 cases), overtube (10 cases) or IT knife (27 cases) over a lapse of 6 years, following submucousal infiltration with saline solution plus adrenalin. They had a 2.1 year endoscopic follow up on average (0.2-7.1). Oesophageal lesions were type IIa and IIb ranging from 5 to 20 mms, half were associated with Barrett’s oesophagus. 81.2% of those in the stomach had an antral localisation; most rectal lesions were localised in the rectum and sigmoid. Results Final histological diagnosis was 41 carcinomas, 13 carcinoids, 7 leiomyomas, 61 high and low dysplasias, 24 adenomas, 2 aberrant pancreas, an angiolipoma and a gist. Most type I and IIa more severe lesions were resected with snare and overtube and flat or depressed ones required cap and IT knife. There were no significant differences between the average size of high degree dysplasias and carcinomas (15 mms vs 19 mms) p=0.17. Lesions could be resected in one fragment in 85% of cases, mainly being done with IT knife and endoscopic overtube. Resected lesions in several fragments were significantly associated with the cap technique (p=0.02) and these with positive edges (3 cases). Recurrence was identified in 1 carcinoid tumour (0.7%), extensive submucous infiltration in 2 lesions and indifferentiation in another case requiring surgical treatment. 2 cases (1.3%) had metachronous lesions after 1 and 3.5 year’s follow-up; these were initially resected with cap and then treated again with mucosectomy leading to complete cure. No bleeding was presented during the procedure or later, perforations or mortality with the 4 EMR techniques in the series. Conclusions Endoscopic resection of the mucous was seen to provide effective and safe treatment in intramucous carcinomas and dysplasias when using the 4 techniques with high adrenaline submucous infiltration. However, resection in fragments was shown to have greater risk of having positive edges and recurrence associated with using the cap.

Keywords : Emr; mucosectomy; recurrence; carcinoma; dysplasia; endoscopic bleeding.

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