In the past cancer of the esophagus was a difficult and problematic cancer to treat. This is a breakthrough.
Endoscopic procedures have always added a great deal of benefit in medicine, reducing the trauma of surgery, allowing scopes to achieve things big and small. To be able to toss surgical resection of the esophagus in favor of what amounts to shaving the inside surface through a scope to get good results as these people from Germany report–wonderful.
Barrett’s cancer is in the distal esophagus, usually associated with chronic irritation by reflux disease.
Endoscopic Mucosal Resection New Gold Standard for Esophageal Adenocarcinoma
Frontline Medical News, 2014 Feb 05, D Napoli
News March 04, 2014
Endoscopic resection for mucosal esophageal adenocarcinoma is safe and highly effective, and should be the new standard of care.
That’s according to Dr. Oliver Pech, whose study in the March issue of Gastroenterology showed a complete remission rate of 93.8% over nearly 5 years of follow-up (doi: 10.1053/j.gastro.2013.11.006).
Dr. Pech, of the University of Regensburg, Germany, and his colleagues looked at 1,000 consecutive patients (mean age, 69 years; 861 men) with mucosal adenocarcinoma of the esophagus, who were referred to a single center between October 1996 and September 2010.
All patients had mucosal Barrett’s carcinoma; lesions judged resectable were first subjected to diagnostic endoscopic resection for staging, even when the macroscopic appearance suggested submucosal disease. Patients with low-grade dysplasia, high-grade dysplasia, and submucosal or more advanced cancer (T1 or greater) were excluded.
In total, 481 patients had short-segment Barrett’s esophagus, and the remainder had long-segment Barrett’s. The majority (n = 493) had intraepithelial adenocarcinoma, according to staging by endoscopic resection, while 240 patients had adenocarcinoma invading the tunica propria, 124 had invasion of the first layer of the muscularis mucosae, and the remaining 143 had disease of the second layer of the muscularis mucosae.
En bloc resection was performed in 508 patients and piecemeal resection in the rest.
The authors found that complete remission, defined as an R0 resection plus one normal surveillance endoscopy, was achieved in 963 (96.3%) of the 1,000 patients in the study.
Among these, recurrence of neoplasia (high-grade dysplasia or adenocarcinoma) was detected in 14.5% of the patients (140 out of the 963) after a median 26.5 months; 115 were successfully retreated with additional endoscopic resection.
That translated to a long-term complete remission rate of 93.8% (mean, 56.6 months) and a 5-year survival rate of 91.5%.
Looking at safety, Dr. Pech reported that 15 patients experienced major complications, including bleeding with a corresponding drop in hemoglobin of at least 2 g/dL (in 14 cases) and perforation (in 1).