Endoscopic band ligation without resection is a technique reported in the literature
for the treatment of subepithelial neuroendocrine tumors and Barrett’s esophagus,
but its use in the treatment of T1 cancer has not been reported [1]
[2]
[3]
[4]. We present a case of T1 esophageal cancer in a patient with contraindications for
surgery treated endoscopically using banding without resection.
A 74-year-old man presented with anemia, and upper endoscopy revealed a nodular area
with raised (10 – 15 mm), eroded mucosa at 28 cm from the incisors ([Fig. 1]).
Fig. 1 Endoscopic view of an esophageal tumor (T1) in a 74-year-old man with anemia.
Biopsy specimens were positive for squamous carcinoma. Computed tomography revealed
no distant metastasis. Surgery was contraindicated owing to the presence of multimorbidities.
Endoscopic ultrasound (EUS), using a radial echoendoscope (GF-UE160-AL5; Olympus,
Hamburg, Germany), showed an isoechoic focal thickening of the surface layers, 4 × 10 mm
in size. The lesion was compatible with mucosal-submucosal (m-sm) T1 tumor because
it had not invaded the muscular propria layer ([Fig. 2]). No pathologic lymph nodes were observed. We decided to treat the lesion in the
same EUS procedure. After marking it with indigo carmine and argon plasma coagulation
(APC) ([Fig. 3 a]), we applied an elastic band (multiband EMR Duette; Cook Ireland Ltd, Limerick,
Ireland) without carrying out resection ([Fig. 3 b]). At the last follow-up 12 months later, only a small scar was present at the site
of the banding and biopsy specimens showed no evidence of malignancy ([Fig. 4]).
Fig. 2 Endoscopic ultrasound view of the esophageal tumor (T1).
Fig. 3 Endoscopic treatment of the tumor. a The lesion marked with indigo carmine and argon plasma coagulation (APC). b An elastic band applied without any resection.
Fig. 4 The 12 months’ follow-up endoscopic image showing a small scar at the site of banding.
The drawback of this technique is not having a histological study, which would indicate
the degree of T1 tumor involvement (m or sm), for which the lymph node risk is known
to be 6 % and 29 %, respectively [5]. Presence of lymph node involvement is an indication for surgery with lymphadenectomy
in T1-sm patients with no surgical risk. In our case, the treating team decided that
owing to the patient’s condition, either mucosal or submucosal involvement would not
have changed the clinical management. In conclusion, management of a T1 esophageal
cancer with endoscopic band ligation without resection may be a safe option in patients
for whom surgery is contraindicated.
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