Original ArticleEUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett's esophagus
Section snippets
Patients and methods
The patients in this study were all referred to a single investigator (C.J.L.) for management of BE with HGD or presumed EC of the esophagus or of the esophagogastric junction. Since June 1999, we have carried out a protocol in these patients, beginning with the performance of endoscopy with repeat biopsies and EUS. Consecutive patients were included in the study if HGD and EC, on biopsy, was found in SSBE (<3 cm in length in either circumferential or tongue extension) or in focal nodular
Results
Initial EUS was performed on 48 consecutive patients (36 men, 12 women) with HGD (25 patients) and possible EC (23 patients) complicating BE (Figs. 2A and 2B). The mean age of the patients was 69 years (range 36-87 years). EUS examination diagnosed submucosal invasion in 8 patients (two with suspicion of regional lymph-node metastases adjacent to the tumor), and these 8 patients underwent esophagectomy and lymph-node dissection. EUS was accurate compared with surgical pathology in 7 of these 8
Discussion
Endoscopic therapy has shown considerable promise as a minimally invasive approach to patients with BE and HGD (previously called carcinoma in situ, Tis) or adenocarcinoma confined to the mucosa (T1m).25, 26 The aim of endoscopic therapy is to achieve a curative effect similar to surgery because of the extremely low incidence of lymph-node metastasis in these early stages27, 28, 29 while avoiding the considerably higher rates of mortality and morbidity associated with esophagectomy.30, 31, 32
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Presented, in part, at the annual meeting of the American Society for Gastrointestinal Endoscopy, Digestive Diseases Week, May 15-20, 2004, New Orleans, Louisiana (Gastrointest Endosc 2004;59:AB90).