Abstracts
scheduled after ESD. Patients with invasion depthRmuscularis mucosa (MM) were recommended additional treatment as surgery or chemoradiotherapy. Main outcomes were the long-term outcome as overall and cause-specific survival rates. Secondary outcomes were en bloc, complete (R0) resection rates and adverse events. Results: There was no significant difference in gender, location, diameter, circumference, and depth of invasion between each group, whereas depressed endoscopic appearance was higher in younger group. En bloc and complete (R0) resection rates between elderly and younger group were not different (98.2% vs 99.0% and 85.4 vs 93.8). Of these, 175, 53, and 18 of epithelial (EP)/lamina propria (LPM), MM/SM1 (submucosal invasion % 200 mm) and SM2 (deeper than SM1) cancer were diagnosed pathologically. There was no significant difference in adverse events such as perforation, delayed bleeding, stricture formation and aspiration pneumonia between two groups. The median follow up periods in the elderly and younger group were 41.1 and 41.4months, respectively. No significant difference was observed in the five-year overall survival rates of EP/LPM cancer between elderly and younger patients (90.6% vs 95.8%, log rank test pZ0.17), whereas that of MM/ SM1 cancer in elderly group was significant shorter than that of younger group (58.3% vs 89.6%, p!0.01). The cause specific survival rates in either group were 100%. Conclusion: ESD for superficial ESCC with EP/LPM depth in elderly patients might be safe and efficient treatment with favorable long-term survival as well as younger populations.
Image 1. Endoscopic image after endomucosal resection of focal nodule.
Image 2. Endoscopic image of PDT fiber during photodynamic therapy.
Tu1576 Safety and Long-Term Survival of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma in Elderly Patients Yasuaki Nagami*, Masaki Ominami, Masatsugu Shiba, Taishi Sakai, Hirotsugu Maruyama, Junichi Okamoto, Kunihiro Kato, Hiroaki Minamino, Shusei Fukunaga, Fumio Tanaka, Satoshi Sugimori, Noriko Kamata, Hirokazu Yamagami, Tetsuya Tanigawa, Toshio Watanabe, Kazunari Tominaga, Yasuhiro Fujiwara, Tetsuo Arakawa Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka city, Japan Background/Aims: Endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) has been widely accepted due to its high resectability and survival. However, the safety and long-term outcome in elderly patients has not been well-described. The aim of this study is to elucidate the safety and long-term outcome of ESD for ESCC in elderly patients compared with younger patients. Methods: This is a retrospective cohort study in single referral institution. Between February 2006 and October 2013, a total of consecutive 311 patients with 476 superficial ESCC underwent ESD at our hospital. Twenty-four patients who had a history of radiotherapy or chemotherapy for ESCC and 25 patients who had treated for progressive cancer recent year were excluded. Of these, 249 patients (219 men; mean age 67.9 years) who had all been followed up for at least 1 years after ESD were enrolled. In patients with multiple lesions, the Initial, deeper, or larger treated lesion was the target lesion. The enrolled patients were divided into 55 elderly (R75 years old) and 194 younger (!75 years old) patients. Endoscopic surveillance using chromoendoscopy with iodine staining and periodic computer tomography were
AB516 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Tu1577 Endoscopic and Oncologic Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasm Hyungchul Park*1, Do Hoon Kim2, Eun Jeong Gong2, Ji Yong Ahn2, Kwi-Sook Choi2, Jeong Hoon Lee2, Kee Wook Jung2, Kee Don Choi2, Ho June Song2, Hwoon-Yong Jung2, Jin Ho Kim2 1 Internal medicine, Asan medical center, Seoul, Korea (the Republic of); 2 Gastroenterology, Asan medical center, Seoul, Korea (the Republic of) Background and Aims: Endoscopic submucosal dissection (ESD) of superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated clinical outcomes to determine the feasibility and effectiveness of ESD for SENs. Patients and Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were enrolled in this study. The clinical features of patients and tumors, histopathological characteristics, adverse events, the results of ESD, and survival were investigated. Results: 225 patients underwent ESD for 261 lesions, including 69 (26.4%) dysplasia and 192 (73.6%) squamous cell carcinoma (SCC). The median age was 65 years (range: 44-86 years) and the male to female ratio was 21.5:1. Median tumor size was 3712.6 mm (range: 5-85 mm), and median procedure time was 45 minutes (range: 9-160 minutes). En bloc resection (EnR) was achieved in 245 of 261 lesions (93.9%), with complete resection (CR) achieved in 234 lesions (89.7%), and curative resection (CuR) in 200 lesions (76.6%). Adverse events occurred in 43 patients (16.4%) included bleeding (1.5%), perforation (8.4%), and stricture (6.5%). During a median follow up period of 37.1 months (range, 0-96 months), none of patients showed local recurrence. 20 patients had died but none of them were died of esophageal cancer related cause. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD for SENs is a feasible and effective procedure, as indicated by favorable outcomes. Although ESD is technically difficult and more time-consuming than EMR, ESD may be a superior treatment option, because of the higher comorbidity of esophagectomy and the higher incidence of local recurrence rate by EMR.
Tu1578 The Five-Year Survival Rate After Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma Masaki Ominami*, Yasuaki Nagami, Masatsugu Shiba, Taishi Sakai, Hirotsugu Maruyama, Junichi Okamoto, Kunihiro Kato, Hiroaki Minamino, Shusei Fukunaga, Fumio Tanaka, Satoshi Sugimori, Noriko Kamata, Hirokazu Yamagami, Tetsuya Tanigawa, Toshio Watanabe, Kazunari Tominaga, Yasuhiro Fujiwara, Tetsuo Arakawa Gastroentelogy, Osaka City University Graduate School of Medicine, Osaka, Japan Background: The prognosis of advanced-stage esophageal squamous cell carcinoma (ESCC) is poor, whereas early-stage superficial ESCC can be cured by endoscopic resection. Endoscopic submucosal dissection (ESD) is widely accepted as a promising endoscopic treatment for superficial ESCC because of a high complete resection rate. However, there are few reports about long-term outcomes of ESD for superficial ESCC. Aim: Here, we aimed to evaluate the 5-year survival rate and metachronous recurrence of esophageal cancer (MEC) after ESD for superficial ESCC. Methods: This is a retrospective cohort study in single institution. Between February 2006 and November 2009, 94 patients with superficial ESCC underwent ESD at our hospital. Three patients who had a history of radiotherapy or chemotherapy for ESCC and 1 patient who had progressive hepatocellular carcinoma were excluded. Eighty-four patients (93.3%) (73 men; mean age 66.8 years) who had all been followed up for at least 5 years after ESD were enrolled. Endoscopic
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