Endoscopic Mucosectomy for Mucosal Carcinomas in the Esophagus

Superficial esophageal carcinomas, even mucosal carcinomas are increasing in number because of developments in endoscopic diagnosis and chromoendoscopy. In mucosal carcinomas, in which the muscularis mucosa is not invaded, both lymphnode metastasis and lymphatic and vessel invasion are extremely rare. Therefore, these superficial mucosal carcinomas could be treated by endoscopic mucosectomy. Instead, for lesions more than 3 cm in size or multiple lesions spreading widely throughout the esophagus, a blunt esophagectomy without thoracotomy should be performed. We have treated 19 mucosal carcinomas in 15 patients by endoscopic mucosectomy. The techniques of mucosectomy are as follows: (1) The extension of the lesion is determined by iodine staining.(2) The area to be resected is marked by high-frequency electric coagulation.(3) Approximately 5 to 10 ml of saline containing 80, 000-to 160, 000-fold diluted epinephrine and indigocarmine is injected into the submucosal layer of the lesion.(4) Endoscopic mucosectomy is performed, and the lesion is resected.(5) Mucosectomy is followed by iodine staining to assure the complete resection of the lesion. Up to now, no complications following mucosectomy have occurred except for one case of subcutaneous emphysema. This patient recovered in a few days with only antibiotic treatment.