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A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus . BACKGROUND A variety of different endoscopic resection techniques for early stage cancer of the upper GI tract have been described that are more effective than strip biopsy . However , there is no report of a prospective randomized comparison of different techniques . METHODS In a prospective randomized study , 100 consecutive endoscopic resections were performed in 72 patients with early stage esophageal cancer . Fifty endoscopic resections were performed with a " suck-and-ligate " device without prior submucosa injection and 50 with the cap technique with prior submucosa injection of a dilute saline solution of epinephrine . The main assessment criteria were maximum diameter of the resection specimen and of the resection area , and the complication rate . RESULTS No significant differences were observed between the two groups with regard to the maximum diameters and calculated area of the resected specimens ( ligation group : 16.4 [ 4.0 ] x 11 [ 3.1 ] mm/185 [ 84 ] mm ( 2 ) vs. cap group : 15.5 [ 4.1 ] x 10.7 [ 2.7 ] mm/168 [ 83 ] mm ( 2 ) ) , or the maximum diameters and calculated area of the endoscopic resection ulcers after 24 hours ( ligation group : 20.6 [ 4.8 ] x 14.3 [ 4.5 ] mm/314 [ 160 ] mm ( 2 ) vs. cap group : 18.9 [ 5.1 ] x 12.9 [ 3.8 ] mm/260 [ 145 ] mm ( 2 ) ) . There was only a slight advantage ( greater diameter of resection specimens ) for the ligation group in patients who had prior endoscopic treatment . There was one minor episode of bleeding in each group ; there was no severe complication . In 41 of 72 patients ( 57 % ) , further endoscopic therapy after endoscopic resection was necessary because of residual neoplasia at the first follow-up endoscopy after resection ( 61 of 100 resection specimens [ 61 % ] had lateral margins that could not be evaluated because of coagulation artifact or contained malignancy but with the base of the lesion free of tumor ) . CONCLUSIONS The cap technique with submucosa injection and the ligation technique without submucosa injection are similar with respect to efficacy and safety for endoscopic resection of early stage esophageal cancers .
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Intervention_Physical
endoscopic resection techniques
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Intervention_Surgical
endoscopic resection techniques
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Intervention_Surgical
endoscopic resections
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Intervention_Surgical
Fifty endoscopic resections
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Intervention_Surgical
suck-and-ligate " device without prior
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Intervention_Physical
submucosa injection
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Intervention_Surgical
and
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Intervention_Pharmacological
the cap technique with prior submucosa injection of a dilute saline solution of epinephrine
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Intervention_Educational
cap technique
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Intervention_Educational
ligation technique
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Outcome_Other
maximum diameter of the resection specimen and of the resection area
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Outcome_Adverse-effects
complication rate
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Outcome_Other
maximum diameters
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Outcome_Other
area of the resected specimens
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Outcome_Other
maximum diameters and calculated area of the endoscopic resection ulcers
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Outcome_Adverse-effects
bleeding
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Outcome_Physical
residual neoplasia
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Participant_Sample-size
72 patients
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Participant_Condition
early stage esophageal cancer