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Sa1088 Highly Selective Targeted Endoscopic Mucosal Resection for Early Esophageal Adenocarcinoma Using Combined Optical Endomicroscopic Modalities
AGA Abstracts
tumor location (anterior wall: 33.6% vs. 9.1%, greater curve: 15.7% vs. 54.5%). Multivariate analysis revealed that pretreatment antral or pyloric deformity (OR: 10.787; 95% CI: 1.23594.226; p=0.031) and circumferential extension of > 3/4 (OR: 1.121; 95% CI: 4.041-1.207; p=0.003) were independent risk factors for post-ESD stricture. Conclusions: Antral or pyloric deformity and sub-circumferential resection over 75% of the circumference are independent risk factors for post-ESD stricture.
Sa1088 Highly Selective Targeted Endoscopic Mucosal Resection for Early Esophageal Adenocarcinoma Using Combined Optical Endomicroscopic Modalities Parit Mekaroonkamol, George Philips, Steven Keilin, Field F. Willingham, Qiang Cai, Kevin E. Woods Barrett's esophagus is a common premalignant lesion with increasing prevalence in western countries. As endoscopic surveillance can be subjected to sampling error, the use of optical endomicroscopy can be employed to increase the diagnostic yield. We report the sequential use of volumetric laser endomicroscopy (VLE) and probe-based confocal laser endomicroscopy (pCLE) in the identification and targeted endoscopic mucosal resection (EMR) of an early esophageal adenocarcinoma contained within a non-nodular appearing segment of intestinal metaplasia. An 89-year-old Caucasian female with known history of Barrett's esophagus was referred to our institution after a focal intramucosal adenocarcinoma was found on random biopsies of the distal esophagus. A positron emission tomography scan was performed and negative for any focal fluorodeoxyglucose activity. Her endoscopic evaluation included a repeat upper endoscopy using high definition white light endoscopy, narrow band imaging and an endoscopic ultrasound unremarkable for paraesophageal lymphadenopathy. On detailed mucosal evaluation of the C2M5 Barrett's segment, there was no visible nodularity, ulceration, or mucosal irregularities of the lesion to help localize the site for endoscopic resection. A subsequent volumetric laser endomicroscopy (VLE) was performed in the same session and found a suspicious area in one quadrant above the gastroesophageal junction. To confirm and localize the dysplastic area, a pCLE examination was performed and revealed 2 foci of branched glands and epithelial irregularities, suggesting Barrett's esophagus associated neoplasia.Targeted endoscopic mucosal resections were then performed at these areas. Pathology revealed focal well-differentiated invasive adenocarcinoma and carcinoma in situ on the back ground of high grade dysplasia, staged T1a. Followup sessions of spray cryotherapy were subsequently performed with good success given the patients tortuous esophagus and large hiatal hernia. Early diagnosis and complete endoscopic resection of esophageal adenocarcinoma was made possible in our case because of multimodality endoscopic approach, particularly the use of VLE and pCLE within the same endoscopic session. Highly selective endoscopic mucosal resection can be accurately performed at the high risk sites with optical endomicroscopy guidance. We believe that combined optical endomicroscopic modalities increase the diagnostic yield of each endoscopic session and provide potential important histological staging when targeted resection is employed. The cost effectiveness of such approach should be further evaluated in future studies.
Pathology revealed focal well-differentiated invasive adenocarcinoma and carcinoma in situ on the back ground of high grade dysplasia
Sa1089 Survival Analysis of Early Esophageal Cancer in Relation to Anatomical Location of Tumor: Endoscopic Therapy Versus Esophagectomy Samip J. Parikh, Venu Gangireddy, Sumanth Daram Introduction: Endoscopic therapy (EET) has shown to be equally effective to esophagectomy (EST) in patients with early esophageal cancer (EEC). The anatomical location of tumor is known to play a key role in staging of patients with esophageal squamous cell carcinoma. However, similar outcomes have not been looked at for esophageal adenocarcinoma. It is also not known whether anatomical location of tumor affects outcomes with EET compared to EST. Objective: To compare EEC related mortality with respect to the anatomical location of tumor in patients treated with EET or EST. Design and setting: Population based study Methods: The data was obtained from Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. We only included microscopically confirmed cases with EEC (i.e., stage T0 and T1a) that were treated with either EET or EST between the years 1998 and 2011. Kaplan-Meier and Cox regression analyses were performed to obtain 5-year EEC related survival, mortality, and outcomes based on the anatomical location, histology, and treatment modality. ‘Untraced' cases were excluded from the study. Results: Out of a total 698 patients [mean (± SE) age: 63.77 ± 0.41 years, 80.9% males, 92% whites], 31(4.4%), 98 (14.0%), and 569 (81.5%) had upper, mid, and lower EEC respectively. Histologically, 14.3% and 72.6% were squamous cell carcinoma and adenocarcinomas respectively. 19.1% patients underwent EET and 89.9% had EST. Using multivariate cox regression analysis, EEC related mortality did not differ for mid [HR (95% CI): 1.20 (0.50 - 2.85), p = 0.68] and upper [HR (95% CI): 0.86 (0.39 - 1.93), p = 0.72] compared to lower when adjusted for age, race, gender, size of tumor, histology, staging, and type of treatment. Additionally, EEC related mortality did not differ by location of tumor for squamous cell carcinoma or adenocarcinoma. Conclusion: EEC related 5-year mortality did not differ by the location of tumor or histology. EEC related overall 5-year survival with EET is comparable to that with EST.
Selective targeted endoscopic mucosal resection
AGA Abstracts
S-220
tumor location (anterior wall: 33.6% vs. 9.1%, greater curve: 15.7% vs. 54.5%). Multivariate analysis revealed that pretreatment antral or pyloric deformity (OR: 10.787; 95% CI: 1.23594.226; p=0.031) and circumferential extension of > 3/4 (OR: 1.121; 95% CI: 4.041-1.207; p=0.003) were independent risk factors for post-ESD stricture. Conclusions: Antral or pyloric deformity and sub-circumferential resection over 75% of the circumference are independent risk factors for post-ESD stricture.
Sa1088 Highly Selective Targeted Endoscopic Mucosal Resection for Early Esophageal Adenocarcinoma Using Combined Optical Endomicroscopic Modalities Parit Mekaroonkamol, George Philips, Steven Keilin, Field F. Willingham, Qiang Cai, Kevin E. Woods Barrett's esophagus is a common premalignant lesion with increasing prevalence in western countries. As endoscopic surveillance can be subjected to sampling error, the use of optical endomicroscopy can be employed to increase the diagnostic yield. We report the sequential use of volumetric laser endomicroscopy (VLE) and probe-based confocal laser endomicroscopy (pCLE) in the identification and targeted endoscopic mucosal resection (EMR) of an early esophageal adenocarcinoma contained within a non-nodular appearing segment of intestinal metaplasia. An 89-year-old Caucasian female with known history of Barrett's esophagus was referred to our institution after a focal intramucosal adenocarcinoma was found on random biopsies of the distal esophagus. A positron emission tomography scan was performed and negative for any focal fluorodeoxyglucose activity. Her endoscopic evaluation included a repeat upper endoscopy using high definition white light endoscopy, narrow band imaging and an endoscopic ultrasound unremarkable for paraesophageal lymphadenopathy. On detailed mucosal evaluation of the C2M5 Barrett's segment, there was no visible nodularity, ulceration, or mucosal irregularities of the lesion to help localize the site for endoscopic resection. A subsequent volumetric laser endomicroscopy (VLE) was performed in the same session and found a suspicious area in one quadrant above the gastroesophageal junction. To confirm and localize the dysplastic area, a pCLE examination was performed and revealed 2 foci of branched glands and epithelial irregularities, suggesting Barrett's esophagus associated neoplasia.Targeted endoscopic mucosal resections were then performed at these areas. Pathology revealed focal well-differentiated invasive adenocarcinoma and carcinoma in situ on the back ground of high grade dysplasia, staged T1a. Followup sessions of spray cryotherapy were subsequently performed with good success given the patients tortuous esophagus and large hiatal hernia. Early diagnosis and complete endoscopic resection of esophageal adenocarcinoma was made possible in our case because of multimodality endoscopic approach, particularly the use of VLE and pCLE within the same endoscopic session. Highly selective endoscopic mucosal resection can be accurately performed at the high risk sites with optical endomicroscopy guidance. We believe that combined optical endomicroscopic modalities increase the diagnostic yield of each endoscopic session and provide potential important histological staging when targeted resection is employed. The cost effectiveness of such approach should be further evaluated in future studies.
Pathology revealed focal well-differentiated invasive adenocarcinoma and carcinoma in situ on the back ground of high grade dysplasia
Sa1089 Survival Analysis of Early Esophageal Cancer in Relation to Anatomical Location of Tumor: Endoscopic Therapy Versus Esophagectomy Samip J. Parikh, Venu Gangireddy, Sumanth Daram Introduction: Endoscopic therapy (EET) has shown to be equally effective to esophagectomy (EST) in patients with early esophageal cancer (EEC). The anatomical location of tumor is known to play a key role in staging of patients with esophageal squamous cell carcinoma. However, similar outcomes have not been looked at for esophageal adenocarcinoma. It is also not known whether anatomical location of tumor affects outcomes with EET compared to EST. Objective: To compare EEC related mortality with respect to the anatomical location of tumor in patients treated with EET or EST. Design and setting: Population based study Methods: The data was obtained from Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. We only included microscopically confirmed cases with EEC (i.e., stage T0 and T1a) that were treated with either EET or EST between the years 1998 and 2011. Kaplan-Meier and Cox regression analyses were performed to obtain 5-year EEC related survival, mortality, and outcomes based on the anatomical location, histology, and treatment modality. ‘Untraced' cases were excluded from the study. Results: Out of a total 698 patients [mean (± SE) age: 63.77 ± 0.41 years, 80.9% males, 92% whites], 31(4.4%), 98 (14.0%), and 569 (81.5%) had upper, mid, and lower EEC respectively. Histologically, 14.3% and 72.6% were squamous cell carcinoma and adenocarcinomas respectively. 19.1% patients underwent EET and 89.9% had EST. Using multivariate cox regression analysis, EEC related mortality did not differ for mid [HR (95% CI): 1.20 (0.50 - 2.85), p = 0.68] and upper [HR (95% CI): 0.86 (0.39 - 1.93), p = 0.72] compared to lower when adjusted for age, race, gender, size of tumor, histology, staging, and type of treatment. Additionally, EEC related mortality did not differ by location of tumor for squamous cell carcinoma or adenocarcinoma. Conclusion: EEC related 5-year mortality did not differ by the location of tumor or histology. EEC related overall 5-year survival with EET is comparable to that with EST.
Selective targeted endoscopic mucosal resection
AGA Abstracts
S-220