Endoscopic Resection of Regressed Early Esophageal Cancer: Report of a Case

完整切除近乎消失的早期食道癌：一病例報告

謝詠諭(Yung-Yu Hsieh) ； 魏國良(Kuo-Liang Wei) ； 董水義(Shui-Yi Tung) ； 張德生(Te-Sheng Chang) ； 林博彥(Paul-Yann Lin) ； 吳正雄(Cheng-Shyong Wu)

《臺灣消化醫學雜誌》 30卷3期 (2013/09) Pp. 285-289

https://doi.org/10.6557/GJT.201309_30(3).0007

摘要

臨床上我們偶爾遇到癌症潰瘍的消失，即所謂的惡性循環。但這常發生在早期胃癌。在此，我們提出一個早期食道癌併潰瘍案例，在追蹤過程中潰瘍消失。因此病灶位於距門齒38 cm處且有逆流性食道炎，胃酸逆流可能是此案例有潰瘍的惡性循環之原因。內視鏡超音波對於診斷TN有很好的敏感度與特異性。此案例中懷疑為肌肉層侵犯，但ESD切下的檢體經病理檢查證實未侵犯到肌肉層。內視鏡超音波過度分期的原因可能為早期食道癌旁局部發炎、水球過度擴張、未能準確定位小型非環狀侵犯癌。結論，針對胃鏡判斷之早期食道癌，內視鏡超音波確認無肌肉層侵犯之病患，黏膜下剝離術可完整切除早期食道癌。

關鍵字

內視鏡黏膜下剝離術 ； 早期食道癌

並列摘要

Regression of cancerous ulcers is unusual, but when it does occur, it is often associated with early gastric cancer (EGC). This entire process of growth and regression is referred to as a malignant cycle. Here, we describe the clinical course of a patient with early esophageal cancer (EEC) presenting an ulcer, which regressed in the follow-up period. The lesion was located in the esophagus, 38 cm from the incisor. and reflux esophagitis was also present. The concept of acid reflux induced malignant cycle may be the reason. Endoscopic ultrasonography (EUS) usually has good sensitivity and specificity in determining the TN stage. In this case, endoscopic submucosal dissection (ESD) was performed, even though EUS before treatment suggested the involvement of the muscularis propria (MP) layer. Complete resection was achieved without MP layer involvement. Possible reasons for the overstaging of EUS included focal inflammation of early esophageal cancer, over-inflation of the water-filled balloon surrounding the ultrasound transducer, and an imprecise localization of a small, non-circumferential neoplasm.In conclusion, for early esophageal cancer, ESD may be an option in cases where the esophagus can be preserved, and is a potential treatment for early esophageal cancer.

並列關鍵字

endoscopic submucosal dissection (ESD) ； early esophageal cancer (EEC)