Endoscopy 2018; 50(04): S9
DOI: 10.1055/s-0038-1637049
ESGE Days 2018 oral presentations
20.04.2018 – Upper GI: resection session 1
Georg Thieme Verlag KG Stuttgart · New York

IS LUGOL NECESSARY FOR ENDOSCOPIC RESECTION OF SQUAMOUS CELL NEOPLASIA OF THE ESOPHAGUS?

A Ferreira
1   Hospital Beatriz Ângelo, Gastroenterology, Loures, Portugal
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
C Mouradides
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
E Cuadrado Robles
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
R Yeung
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
R Duran
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
C Snauwaert
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
A Mourin-Jouret
3   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Anatomie Pathologique, Brussels, Belgium
,
H Piessevaux
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
,
P Deprez
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Service d'Hépato-gastro-Entérologie, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Mucosal chromoendoscopic enhancement with Lugol solution improves the sensitivity for squamous cell carcinoma (SCC) diagnosis. However, it is time-consuming and associated with increased esophageal motility which may difficult endoscopic resection. Narrow band imaging (NBI) is easier to use and has been shown to be useful for SCC diagnosis. Our aim was to assess the effectiveness of Lugol when compared to NBI for lesion demarcation in esophageal SCC.

Methods:

Retrospective observational cohort study of patients with esophageal SC neoplasia submitted to en-bloc EMR between 1999 and 2017 in an academic center. Patient demographic, lesion (size, morphology, histology and complete resection), procedural characteristics (endoscopist, scope model, lugol usage and resection technique) and follow-up data were collected from electronic records. Two groups were defined based on lugol usage. The primary outcome was complete lateral resection (CLR). Multivariate regression was used to adjust to potential confounders.

Results:

A total of 101 patients had 132 lesions. Mean age was 65 ± 9 years and 65.3% were male. The lesions were in the middle (60.8%) and lower (20.8%) esophageal thirds. Mean diameter was 29.6 ± 16.8 mm with Paris morphology 0-IIb in 42.3% and 0-IIa in 29.3%. Lugol was used in 51.2%, submucosal dissection in 92.3% and 78% had invasive histology.

CLR rate was complete for invasive carcinoma in 90.9% in Lugol group and 95.2% in NBI group (OR 0.500; IC 0.119 – 2.092; p = 0.343) and 65.2% vs. 66.7% (p = 0.856) for dysplasia complete lateral resection. The effect remained non-significant even after adjusting for potential confounders. There were 2 relapses with lugol and 1 in NBI group.

In an exploratory analysis for predictive factors of CLR (scope, previous local treatment, lesion morphology, diameter, location and EMR technique), the only significant association was with the scope model (p = 0.005).

Conclusions:

Mucosal inspection with lugol before EMR of esophageal SCC was not associated with increased CLR when compared to NBI.