[The value of endoscopic mucosal resection for dysplasia and early-stage cancer of the esophagus and gastric cardia].

OBJECTIVE: To evaluate the long-term effect and clinical value of endoscopic mucosal resection (EMR) with transparent cap for dysplasia and early-stage cancer of the esophagus and gastric cardia. METHODS: From September 1996 to June 2007, 154 lesions in the esophagus or gastric cardia of 147 patients were treated using EMR with transparent cap. Among the lesions, there were 69 early-stage squamous-cell carcinomas in 64 patients and 47 squamous cell precancerous lesions of the esophagus in 45 patients, with an average lesion size of (14.8 +/- 6.1) mm (range, 3-40 mm), furthermore, there were 23 early-stage adenocarcinomas in 23 patients and 15 precancerous lesions in the gastric cardia in 15 patients, with an average lesion size of (8.2 +/- 4.3) mm (rang, 5-25 mm). All lesions were finally confirmed histopathologically. RESULTS: Of the 154 lesions, 139 (90.3%) were resected completely through EMR procedure. A close relationship between the complete resection rate and the lesion size was observed. The bigger the lesion size, the lower the complete resection rate. Endoscopic follow-up was carried out in 7 patients for more than 10 years, in 43 for 5 - 10 years, in 31 for 3 - 5 years and in 66 for less than 3 years. Of 11 dead patients during following-up, 10 died of other diseases, only 1 of recurrence. The 5-year survival rate was 96.2% for early-stage esophageal cancer, and 100% for early cancer of the gastric cardia. Perioperative complications included oozing bleeding in 5 patients (3.4%) and stricture in 1 (0.7%), no perforation occurred in this series. CONCLUSION: Endoscopic mucosal resection is suitable to treat precancerous lesions or early-stage esophageal cancers without invasion into submucosa. Compared with conventional resection through open thoracotomy, similar long-term survival and curative effect can be achieved by this EMR treatment, preserving a good quality of life.

[Clinical value of esophageal mucosal iodine stain during esophagoscopy for patients without swallowing symptoms].

OBJECTIVE: To investigate the clinical value of esophageal mucosal iodine stain during esophagoscopy for patients with early esophageal carcinoma or precancerous lesions without swallowing symptoms, through analyzing the correlation between endoscopic findings and pathological results of biopsy on the suspicious spots. METHODS: For 366 patients examined by iodine stain during esophagoscopy, the position, size, shape and boundary of all visible unstained lesions were recorded and multiple biopsies were taken on the unstained spots. RESULTS: Before iodine stain, 462 lesions had been discovered in 366 patients. However, 478 abnormal lesions stained in 341 patients were detected after iodine stain, the remaining 25 gave no abnormal findings. More than 1/3 of patients were found to have more than 2 abnormally stained lesions. 28.4% of them (104 cases) had moderate or severe dysplasia or early esophageal cancer. The sensitivity of iodine stain in this series was 89.8%. CONCLUSION: Iodine stain is very useful in detecting occult early esophageal carcinoma and precancerous lesions. The degree of coloration and the margin of suspicious spots are closely correlated with the pathological results.

[Changes of glycogen or sacchariferous materials in esophageal epithelium tissue].

BACKGROUND & OBJECTIVE: It was known that mucosal iodine staining could be used to improve the endoscopic visualization of esophageal premalignant lesion and cancer. However, the method was not used widely because of lacking clear mechanism. This study was designed to investigate the mechanism of esophageal epithelium staining with iodine and changes of glycogen or sacchariferous materials. METHODS: Esophageal epithelium was stained with iodine in endoscopic examination. According to color of tissue, the esophageal carcinoma and premalignant lesion were diagnosed. Glycogen from the esophageal mucous epithelium was extracted with beta-glycerophosphate buffer. The content of glycogen in the tissue speciman was detected by periodic acid-shiff staining (PAS). Protein in the esophageal mucous epithelium was extracted by tissue homogenate method. RESULTS: After iodine staining, the normal epithelium became brown and easier to distinguish normal epithelium from precancerous of premalignant epithelium according to the change of color. Furthermore, normal epithelium slice stained by PAS technique had red reaction but it had no reaction after pretreatment by amylase. However, precancerous and premalignant epithelium tissue slices could not be stained whenever they were pretreated by amylase. The content of glycogen extracted from the esophageal epithelium was lower significantly than those of normal tissue (P < 0.01). But it was no deviation that protein contents of normal esophageal epithelium were compared with carcinoma tissue (P > 0.05). CONCLUSION: These results demonstrated that glycogen and sacchariferous materials in esophageal carcinoma and premalignant lesion tissue decreased significantly and result in light yellow area by iodine staining. It may be helpful for diagnosis of esophageal carcinoma.