Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
  2015 Nov 6  
  A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus  
  Zhang YM, Boerwinkel DF, Qin X, He S, Xue L, Weusten BL, Dawsey SM, Fleischer DE, Dou LZ, Liu Y, Lu N, Bergman JJ, Wang G  

Background and aim
Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band ligator without submucosal lifting. In high-risk areas where ESCC is common and endoscopic expertise is limited, MBM may be a better technique. We aimed to compare MBM to the cap-assisted technique for piecemeal endoscopic resection of esophageal ESCCs.

Patients with mucosal HGIN/ESCC (2 - 6 cm, maximum two-thirds of esophageal circumference) were included. Lesions, delineated by 1.25 % Lugol staining, were randomized to MBM or cap-assisted piecemeal resection. Endpoints were procedure time and costs, complete endoscopic resection, adverse events, and absence of HGIN/ESCC at 3-month and 12-month follow-up. 

Endoscopic resection was performed in 84 patients (59 men, mean age 60) using MBM (n = 42) or the endoscopic resection cap (n = 42). There were no differences in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, P < 0.0001). One perforation, seen after using the endoscopic resection cap, was treated conservatively. Total costs of disposables were lower for MBM (€200 vs. €251, P = 0.04). At 3-month and 12-month follow-ups none of the patients had HGIN/ESCC at the resection site.

Piecemeal endoscopic resection of esophageal ESCC with MBM is faster and cheaper than with the endoscopic resection cap. Both techniques are highly effective and safe. MBM may have significant advantages over the endoscopic resection cap technique, especially in countries where ESCC is extremely common but limited endoscopic expertise and resources exist. (Netherlands trial register: NTR 3246.).

Question posée
La mucosectomie au cap fait-elle mieux que la mucosectomie œsophagienne par section sur ligature élastique (MBM) pour les néoplasies superficielles de l’œsophage ?
Question posée
Etude prospective de 84 patients : La résection est plus rapide et moins couteuse avec le MBM, avec autant de résection complète et sans complication supplémentaire.

Il existe encore une place pour la mucosectomie oesophagienne !! Mais le suivi est trop court pour affirmer l’absence de récidive après mucosectomie piece-meal.