| Background: Esophageal cancer is one of the common malignant tumors in digestive tract. Epidemiological investigations showed that the incidence of esophageal cancer has obvious regional characteristics, focusing on China’s high north, northwest, and Central Asia, South Africa, East Africa, South America, North America. In recent years, we had found that the place with a high incidence of esophageal domestic also showed a high incidence of GCA. there was a common phenomenon of high incidence of esophageal and gastric cardia. Among the patients who accepted the clinical treatment, most of them had been in advanced stage. What’s worse, not only their 5-year survival rate is very low, but also they cost huge but had little effect. Therefore, the prevention strategy which was based on "Early discovery, early diagnosis and early treatment " was the key to improve the quality of life and prognosis.The occurrence and development of esophageal and cardiac carcinoma is a multi factor, multi stage long slow process, need to experience inflammation and dysplasia and early carcinoma and infiltrating cancer multiple pathological change stage. The dysplasia is the most direct precancerous lesion is a necessary stage in the development of normal epithelial cells to cancer. Actually it is a period of a few years or even decades and dynamic process, which provides sufficient time for the observation, track their evolution, intervention and blocking. Endoscopy is not only an effective method for early discovery and diagnosis of esophageal and cardiac carcinoma, but also the important means of the evolution track. So by endoscopic follow-up observation of occurrence and development of changes and characteristics of esophageal and cardia precancerous lesions, investigate the factors related to the natural history, laying the foundation for the formulation of the follow-up plan of scientific and effective therapeutic intervention, so that more timely, effective, is the current key to reduce the incidence of esophageal cancer and cardia cancer, is also the purpose of the our study.Objective:Tracing the evolution of esophageal and cardiac disease by endoscopy, our researches had successfully known the characteristics of diseases’ outcome, furthermore, we had explored the preoperative assessment and treatment follow-up case of the esophagus cardia precancerous lesions and pre-cancerous endoscopic therapy. In a word, we had provided the basis for the prevention and treatment of esophagus and gastric cardia precancerous lesions, early cancer.Method:From 2006 July to 2013 January, our study selected 97637 cases who had accepted endoscopy from the fourth hospital of Hebei Medical University as the research object. We had observed the detection of esophageal and gastric cardia precancerous lesions and early cancer in order to follow up those patients with mild-to-moderate Cardiac dysplasia, contrastive analyzed outcomes features of mild-to-moderate Cardiac dysplasia, meanwhile we also had explored preoperative assessment and postoperative follow-up cases of 179 patients with esophageal severe dysplasia and early cancer and 175 cardia patients’(deadline to 2014 October). What’s more, we had contrastive analyzed preoperative assessment of the accuracy of EUS, preoperative and postoperative pathology consistent rate, the relationship between morphology and pathological lesions and relapse after treatment with different residual ectopic recurrence case of patients who accepted endoscopy with esophageal cardia severe dysplasia and early cancer.Results: 1 the detection results of precancerous lesions and early cancer in esophagus and cardiaIn 97637 cases, the detection rate of esophagus, cardia dysplasia and early cancer were respectively 3.9%, 3.4%. Thereinto, to patients with diseases of the esophagus, the detection rate of m D was 2%( 1978/97637), the MD was 1%( 1006/97637), the SD was 0.5%( 519/97637) and the EC was 0.3%( 327/97637). The detection rate of m D, MD, SD and EC in cardicis were respectively 1.7%, 0.8%, 0.6% and 0.3%. Esophageal dysplasia and early cancer detection rate of male and female were 5.3% and 2.3%, the difference was statistically significant(P<0.05), cardiac dysplasia and early cancer detection were 4% and 2.8% men and women, the difference was statistically significant(P<0.05). The detection rate of esophageal dysplasia and early cancer of men and women have differences with cardia, the difference was statistically significant(P<0.05). Over 50 years and <50 years old group of esophageal dysplasia and early cancer detection rates were 4.6%, 2.6%, the difference was statistically significant between the two groups(P<0.05). More than 50 years old with <50 group of cardia dysplasia and early cancer detection rates were 4.1%, 2%, the difference was statistically significant between the two groups(P<0.05). 2 The follow-up result of mild and moderate dysplasia in esophagus and cardiaThe follow-up results of 223 m D esophageal cases showed that 82% patients were reversed, 12.6% unchanged, 5.6% progression; in 96 cases of esophageal MD,54.2% reverse, 25% matained, 20.8% progress, wherein the esophageal m D and MD, the reverse rate(82%vs54.2%),(12.6%vs25.0%) maintain rate and development rate(5.6%vs20.8%) between the differences were statistically significant(P<0.05). 207 cases of cardiac m D, 83.1% reversed, 10.1% unchanged, 6.8% progress. 54.4% 79 cases of cardiac MD, reverse, 20.3% unchanged, 25.3% progress. The cardiac m D and MD reversal rate(83.1%vs54.4%), to maintain the rate(16.9%vs20.3%) and the rate of progression(13.0%vs25.3%) differences were statistically significant(P<0.05). Esophageal m D and MD interval of the median time to progression was 26 months and 12 months, the difference was statistically significant(P<0.05). Cardiac m D and MD interval of the median time to progression was 23.5 months and 11.5 months, the difference was statistically significant(P<0.05). The progress of the esophagus and cardia m D and MD were respectively after the merger, the median time to progression interval was 17 months and 14.5 months, the difference was statistically significant(P<0.05). 3 The treatment and follow-up of severe dysplasia and early cancer in esophagus and cardia.We performed endoscopic therapy in 179 cases of esophageal and cardia and 175 cases of SD patients with EC. We treated 337 cases of patients underwent endoscopic follow-up, except 5cases of esophageal and 12 cases of cardia patents, the 3 years and 5 year follow-up rates were 79.5%, 60.9% after endoscopic therapy, the 3 year and 5 year survival rates were 100%, 97.9% in esophagus. The 3 year and 5 year survival rates were 97.9%, 93.9% in cardia. A total of 186 lesions, preoperative EUS(Endoscopic ultrasound EUS) assessment of lesion depth of invasion and accuracy 89.2%, on the layer of mucosa(mucosa, m) and submucosa(submucosa, SM) infiltration depth accuracy of judgment are respectively 89.5% and 80%, the difference was statistically significant(P<0.05). 175 cases of cardiac patients with endoscopic treatment, a total of 181 lesions, EUS preoperative assessment of lesion depth of invasion accuracy was 86.2%, the accuracy rate of infiltration depth accuracy of M and SM were respectively 87% and 75% of the judgment, the difference was statistically significant(P<0.05). Most of esophageal lesions with pathologic grade from SD to intramucosal carcinoma(intramucosal carcinoma, IMC) and then to the submucosal carcinoma(submucosal, carcinoma, SMC) increase, the main form is composed of congestion rough(71.9%), erosion(54.3%) to(80%) nodular changes change, the difference has statistical significance of its morphology the distribution(P<0.05). The majority of cardiac lesions with pathologic grade by SD-IMC-SMC was enhanced, the main form is composed of hyperaemia erosion(73.4%), depression(77.8%) to the nodular changes(75%) of the change, the difference was statistically significant between the species distribution(P<0.05). Esophageal patients with preoperative and postoperative pathology coincidence rate is 82.3%, higher than that of patients with preoperative and postoperative pathology coincidence rate was 72.4%, with significant difference between the two groups(P<0.05). After endoscopic therapy, 179 cases of esophageal and cardiac patients 175 cases recurrence rates were 7.7%, 18.9%, the difference was statistically significant(P<0.05). Postoperative follow-up of patients with esophagus and cardia patients with metachronous ectopic recurrence rate were 19% and 7.7%, the difference was statistically significant(P<0.05).Conclusion: 1 The cases of 97637 who underwent endoscopic examination showed thatesophagus, cardia precancerous lesions and early cancer in male patientsdetection rate was higher than that in female, more significant esophageal;The detection in over the age of 50 patients was higher than that under 50. 2 Endoscopic follow-up results showed that esophageal and cardiac light tomoderate dysplasia prognosis and cardiac moderate dysplasia is morelikely to occur in; and compared with pathological grade of earlyesophageal lesions and cardiac disease progress time interval shorter. 3 EUS is an effective means of assessment before endoscopic treatment. Theaccuracy of the judgment on depth of invasion of esophageal lesions is89.2%, the accurate rate of the judgment on cardiac lesion depth ofinvasion was 86.2%. 4 Endoscopic mucosal resection for precancerous lesions and early cancerpreoperative and postoperative pathological rate of esophageal 82.3%higher than 72.4%. 5 Endoscopy follow-up is particularly important, we should pay specialattention to the recurrence of esophageal and cardiac recurrence andcardiac. 6 The results of endoscopic mucosal resection show that the 5 year survivalrate of esophageal lesions after treatment is 97.9% years,the 5 yearssurvival rate of cardiac lesions is 93.9%. |
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