title: Extensive (8 to 12 cm2) noncircumferential endoscopic mucosal resection for early esophageal cancer.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) is an appealing method for treating intramucosal esophageal cancer but must comply with the following stringent requirements: proper preoperative staging, complete resection of the lesion, obtaining a resected specimen for histologic analysis of safety margins, and squamous reepithelialization without stricture formation.
  
  
  METHODS
  A rigid esophagoscope was created to resect up to 12 cm(2) of esophageal mucosa in a single specimen and at a constant depth through the submucosa. Under visual control, the esophageal mucosa is sucked into a transparent window and resected with a thin diathermy wire loop in 10 seconds. After extensive preclinical studies in a sheep model, this article reports our early experience in humans.
  
  
  RESULTS
  Twenty-one hemi-circumferential EMRs were performed for 11 dysplastic Barrett's esophagi and 10 early squamous cell carcinomas with no perforation, one hemorrhage controlled by embolization of the left gastric artery, and one incomplete resection. Deep safety margins were clear in 19 of 21 resected specimens (2 patients, unfit for operations, had submucosal invasion of squamous cell carcinoma and adenocarcinoma, respectively). Lateral margins were not clear by definition in 7 circumferential Barrett's esophagi, but were clear in 4 incomplete Barrett's esophagi and 10 early squamous cell carcinomas.
  
  
  CONCLUSIONS
  Large EMRs of 12 cm(2) can safely be performed at the submucosal level in the esophagus. Although feasible in one session, circumferential EMR in humans is not yet advisable because of the risk of stricture formation during the healing phase. The rate of complications of this series of 21 EMRs in humans is acceptable.
authors.affiliation: Otolaryngology, Head and Neck Surgery Department, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. philippe.monnier@chuv.ch
authors.forename: Philippe
authors.initials: P
authors.lastname: Monnier
authors.forename: Yves
authors.initials: Y
authors.lastname: Jaquet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Radu
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Pilloud
authors.forename: Pierre
authors.initials: P
authors.lastname: Grosjean
authors.forename: Anette
authors.initials: A
authors.lastname: Escher
authors.forename: Elsa
authors.initials: E
authors.lastname: Piotet
authors.forename: Snezana Andrejevic
authors.initials: SA
authors.lastname: Blant
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009367:Neoplasm Staging