Demarcation of early esophageal squamous cell carcinoma during endoscopic submucosal dissection

Abstract

Lugol's iodine staining (LIS) and narrow-band imaging (NBI) are currently the most common methods applied in demarcating early esophageal squamous cell carcinoma (EESCCs) during endoscopic submucosal dissection. The purpose of the present study was to investigate the effects on clinical outcomes in comparison between LIS and NBI for the demarcation of EESCCs during endoscopic submucosal dissection. This was a single-center, retrospective, cohort study. A total of 172 patients were involved. 109 patients received demarcation of the lesion by LIS and 63 patients by NBI. Data on baseline characteristics, clinical outcomes and follow-up information were collected for analyses. The mean diameter of the lesions was 3.9 ± 1.5 cm. R0 resection rate was 89.5%. The rate of total and in-hospital adverse events was 25.6% and 9.3%. The cumulative recurrence rate was 2.9% and 3-year disease-specific survival rate was 98.3%. Compared to patients of the LIS group, patients of the NBI group showed significantly shorter procedure time (44.8 ± 32.2 v.s. 57.0 ± 40.6, P = .044), lower rate of using of scopolamine butylbromide (19.0% vs 35.8%, P = 0.021), reduced number of clips used (1.3 ± 1.2 vs 1.8 ± 1.5, P = .017) and alleviated discomfort evaluated by visual analog system score after operation (4.7 ± 0.8 vs 5.5 ± 1.0, P < .001). There was no significant difference of R0 resection rate, margin status, adverse events, cumulative recurrence rate and 3-year disease-specific survival rate between the two groups. Demarcation of EESCCs by NBI could achieve comparable accuracy and clinical outcomes with more convenience and safety compared with demarcation by LIS.

Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm

“…A prospective comparative study confirmed the higher specificity of NBI staining in tumor detection [9]. Two retrospective studies investigating the appropriate staining method for delineating the lateral extent of the tumor before endoscopic resection showed no difference between NBI and Lugol staining [10, 11]. Due to the available data, the lateral resection margins should be determined using virtual chromoendoscopy or Lugol staining before endoscopic resection of an esophageal SCC.…”

Lugol como causa inusual de anafilaxia después de la colposcopia. Reporte de un caso clínico

“…2 Otros usos de lugol incluyen el marcaje durante la disección submucosa endoscópica en pacientes con carcinoma esofágico en estadio precoz y en el tratamiento preoperatorio de quienes padecen enfermedad de Graves. 2,3 A pesar de su uso generalizado, se han reportado casos excepcionales de reacciones alérgicas y hasta la fecha no se ha descrito su potencial alergenicidad. De acuerdo con la bibliografía disponible al momento, exponemos el segundo caso de reacción alérgica a lugol.…”

Upper Gastrointestinal Endoscopy for Screening or Surveillance: Complication Avoidance and a Closer Look at the Esophagus

“…A recent meta-analysis revealed no significant difference in diagnostic sensitivity between the two methods (88% versus 92%); it also revealed that NBI has a significantly higher specificity than Lugol's iodine chromoendoscopy (88% versus 82%) [7]. Furthermore, several observational studies reported no significant difference in complete resection rate between the two methods [8,9].…”