Endoscopy 2016; 48(04): 330-338
DOI: 10.1055/s-0034-1393358
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus

Yue-Ming Zhang*
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
David F. Boerwinkel*
2   Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
,
Xiumin Qin
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Shun He
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Liyan Xue
3   Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Bas L. A. M. Weusten
2   Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
4   Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
,
Sanford M. Dawsey
5   Department of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
,
David E. Fleischer
6   Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
,
Li-Zhou Dou
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Yong Liu
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Ning Lu
3   Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Jacques J. G. H. M. Bergman
2   Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
,
Gui-Qi Wang
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
› Author Affiliations
Further Information

Publication History

submitted: 02 February 2015

accepted after revision: 16 September 2015

Publication Date:
06 November 2015 (online)

Preview

Background and aim: Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band ligator without submucosal lifting. In high-risk areas where ESCC is common and endoscopic expertise is limited, MBM may be a better technique. We aimed to compare MBM to the cap-assisted technique for piecemeal endoscopic resection of esophageal ESCCs.

Methods: Patients with mucosal HGIN/ESCC (2 – 6 cm, maximum two-thirds of esophageal circumference) were included. Lesions, delineated by 1.25 % Lugol staining, were randomized to MBM or cap-assisted piecemeal resection. Endpoints were procedure time and costs, complete endoscopic resection, adverse events, and absence of HGIN/ESCC at 3-month and 12-month follow-up. 

Results: Endoscopic resection was performed in 84 patients (59 men, mean age 60) using MBM (n = 42) or the endoscopic resection cap (n = 42). There were no differences in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, P < 0.0001). One perforation, seen after using the endoscopic resection cap, was treated conservatively. Total costs of disposables were lower for MBM (€200 vs. €251, P = 0.04). At 3-month and 12-month follow-ups none of the patients had HGIN/ESCC at the resection site.

Conclusion: Piecemeal endoscopic resection of esophageal ESCC with MBM is faster and cheaper than with the endoscopic resection cap. Both techniques are highly effective and safe. MBM may have significant advantages over the endoscopic resection cap technique, especially in countries where ESCC is extremely common but limited endoscopic expertise and resources exist. (Netherlands trial register: NTR 3246.)

* These authors contributed equally to this work