ENDOSCOPIC SNARE MUCOSECTOMY IN THE ESOPHAGUS WITHOUT ANY ADDITIONAL EQUIPMENT - A SIMPLE TECHNIQUE FOR RESECTION OF FLAT EARLY CANCER

Background and Study Aims: Endoscopic mucosal resection of early esoph ageal cancer has increasingly proved to be an effective treatment moda lity, especially if the tumor has not invaded the muscularis mucosae. Different techniques have been introduced, using an overtube, double-c hannel endoscope. or suction cap. We have not found that these devices are required for snare resection in the esophagus. Patients and Metho ds: Over a period of two years (1994-1996), seven patients (five men a nd two women, age range 59-88) with early esophageal cancer defined by endosonography (3 cm or less in size, Limited to the submucosal layer ) were treated using a simplified technique of endoscopic snare resect ion using a monopolar diathermic polypectomy snare made of monofilamen t steel wire, The snare was positioned around the lesion, and then clo sed while pressing the snare against the mucosa and applying suction t o draw the lesion into the snare, Pure coagulation current Has used fo r resection, If necessary a piecemeal technique was used to achieve co mplete removal. Results: Complete removal was achieved in one session in all seven cases. No complications were observed, Two patients under went radical surgery with no tumor remnant or metastatic I mph node in the resected specimen. All patients have remained free of recurrence during a median follow-up period of seven months (range 3-22 months). Two patients died of cardiovascular disease four and eight months afte r endoscopic mucosal resection. Conclusion: Small carl esophageal canc er can be safely removed with a simplified method of endoscopic snare resection using a standard monofilament polypectomy snare.