Usefulness of EMR with an oblique aspiration mucosectomy device compared with strip biopsy in patients with superficial esophageal cancer

Background. EMR is now widely accepted as a treatment option for superficial esophageal cancer. Endoscopic oblique aspiration mucosectomy with an oblique aspiration mucosectomy device was performed, and the results were compared retrospectively with those of conventional strip biopsy. Methods: Strip biopsy (April 1991 through October 1999) or endoscopic oblique aspiration mucosectomy (November 1999 through December 2002) was performed in a consecutive series of patients with superficial esophageal squamous-cell carcinoma. Variables assessed were size of resection specimens, rate of complete resection, and complications. Results: Of the consecutive series of 66 patients with superficial esophageal cancer, 27 underwent strip biopsy and 39 had endoscopic oblique aspiration mucosectomy. The two groups were similar with respect to age, gender, and lesion macroscopic appearance. The endoscopic oblique aspiration mucosectomy group had a significantly greater mean depth of tumor invasion and had significantly more large lesions vs. the strip biopsy group. The mean longest diameter of resection specimens was significantly greater with endoscopic oblique aspiration mucosectomy (23.9 [5.2] mm) than with strip biopsy (15.2 [4.9] mm) (p < 0.001). The en bloc resection rate was 33.3% (9/27) in the strip biopsy group and 46.2% (18/39) in the endoscopic oblique aspiration mucosectomy group (p = 0.322). Despite larger lesion size in the endoscopic oblique aspiration mucosectomy group, the complete resection rate was similar between the strip biopsy (70.4%) and endoscopic oblique aspiration mucosectomy (74.4%) groups (p = 0.783). The complete resection rate for lesions 30 mm or greater in diameter was slightly but not significantly higher in the endoscopic oblique aspiration mucosectomy group (84.4%) compared with the strip biopsy group (70.4%) (p > 0.999). With respect to complications, the rates of bleeding and submucosal hematoma were similar. Esophageal stenosis occurred after the procedure in 3 patients in the endoscopic oblique aspiration mucosectomy group. All were managed by endoscopic dilation, and symptoms improved. Conclusions: Endoscopic oblique aspiration mucosectomy is safe and effective for the treatment of superficial esophageal cancer.