Clinical Studies On Endoscopic Diagnosis And Treatment Of Early Esophageal Cancer And Precancerous Lesion In Municipal Hospitals

ObjectiveThe paper works to probe into the clinical studies on endoscopic diagnosis and treatment of early esophageal cancer and precancerous lesion in the city-level hospitals,to provide empirical support to popularize endoscopic techniques in municipal hospitals.MethodFrom October,2013 to October,2015,several municipal hospitals in the Eastern Henan province,in the central C hina,have engaged in the retrospective researches on endoscopic diagnosis and therapy of early esophageal cancer and precancerous lesion.Based on 170 suspicious lesion cases – including esophageal mucosa roughness,heave,erythema,erosion,and ulceration-detected by ordinary white light endoscopy,chromoendoscopy combined with magnifying endoscopy with narrow-banding imaging(ME-NBI)were adopted to observe and evaluate the two inspection methods and the coincidence rate of pre-surgery pathological biopsy results.ME-NBI was applied to part intraepithelial papillary capillary loop(IPC L)for 75 patients with early esophageal cancer and precancerous lesion,to assess the coincidence rate of postoperative pathology.75 patients were conducted ESD and surgical treatment,among which 33 cases were in surgical group and 42 patients in ESP treatment group,to analyze the types of lesion(including lesion size,position,and nature),and surgical results(such as surgical pathological diagnosis,complete resection,operative success rate,operation time,bleeding rate,perforating rate,post-operative survival rate,recurrence rate).Result1.170 suspicious patients were detected by ordinary white light endoscopy to be 31 cases of esophagus erythema,45 cases of heave,27 cases of roughness,26 cases of erosion,and 25 cases of ulceration,among which 7 cases are of esophagus erythema and roughness,and 2 cases of erythema and erosion,and 7 cases of erythema and ulceration.86 suspicious lesions of them were identified with chromoendoscopy and ME-NBI technologies,while 75 cases of early esophageal cancer and precancerous lesion were determined by preoperative pathologic examination on suspicious lesions,determining the coincidence rate of ordinary white light endoscopy & Compared with conventional white light endoscopy,chromoendoscopy combined with ME-NBI technique and preoperative biopsy results.2.75 patients with early esophageal cancer and precancerous lesion were identified to be normal based on 2002 Paris digestive tract tumor classification [1] and Inoue’s parting of the IPC L [2].The lesion results of 75 patients(including 15 cases of IV-type,17 cases of V-1,32 V-2,8 V-3 and 3 VN types)diagnosed by ME-NBI observation and post-operative complete resection pathologic results(15 cases of HGIN stage,15 M1 stage,31 M2 stage,12 M3 stage,and 3 SM stages)Comparison found no statistically significant difference(p>0.05).3.Surgical operations for 33 patients with early esophageal cancer and precancerous lesion spent 123±10.3 min on average,cost RMB 21300±2600,and took 13.2±1.3 days for the average inpatient period.Whereas,42 patients with early esophageal cancer and precancerous lesion for ESD therapy went through 58.0±15.5 min in the treatment,RMB 12,300±1,100 for the operation,and 4.0±0.5 days for the hospitalization.Among 42 patients for ESD treatment,8 of them who showed up narrow lesion dissection position,conducted bouginage operation,when patients suffered from bleeding but were endoscopically stanched,while perforation occurred in the operation were successfully clamped by titanium clips;in the postoperative follow-ups,no bleeding or perforation occurred.However,in the 33 cases of surgical group,30 patients suffered from narrow lesion dissection position in different levels,12 people are infected,and 4 patients suffered from anastomotic fistula.The results indicated that: ESD treatment groups outperformed surgical group in terms of operation time,operative fees,inpatient period,a nd post-operative complication,with great statistical significance(P<0.05).4.The most common complication in the ESD operation is bleeding.Based on bleeding grading standards [3],15 cases were identified to be Grade-I bleeding,18 cases of Grade-II,9 Grade-IIIs,which could be effectively stopped without any postoperative delayed hemorrhages.ConclusionOn the occasion of no endoscopic ultrasonography and other advanced instruments,city-level hospitals can achieve satisfactory diagnosis results in morphology parting of IPCL lesions by ME-NBI technology.ESD group is reported superior results to surgical operation group in operation time,treatment costs,hospitalization period,and post-operative complication,and better survival environment.In the ESD process,as one of the most common complications,hemorrhage in the operation arises mostly in the locus medialis and can be stanched under endoscopic treatment.It can be seen that,ESD diagnosis and treatment of early esophageal cancer and preca ncerous lesion can be safe and effective in municipal hospitals,and are more accessible to grass-root patients,representing excellent clinical values for further application.