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( Harshadkumar Rajgor ),( Jeff Butterworth ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: Barretts oesophagus increases the risk of developing oesophageal adenocarcinoma. Over the last 40 years there has been a 6 fold increase in the incidence of oesophageal adenocarcinoma and the incidence rates are increasing at a greater rate than cancers of the colon, breast and lung. Endoscopic mucosal resection is a relatively new technique being used by 2 centres in the greater midlands cancer network. EMR can be used for curative or staging purposes, for high grade dysplasia`s and T1 tumours of the oesophagus. EMR is also suitable for those who are deemed high risk for oesophagectomy EMR has a recurrence rate of 21%. Methods: A retrospective study of prospectively collected data was carried out involving 24 patients who had EMR for curative or staging purposes. Data was collected on effective communication with patients regarding diagnosis and treatment, continuity of care and the use of multidisciplinary teams in managing these patients. The long term effi cacy, cost and complication rates of EMR were considered. Complications included suspicion of residual or recurrent disease that required further treatment with radio frequency ablation. Results: 92% of patients had a confirmed pathological diagnosis prior to endoscopic therapy or oesophagectomy. In 54% of cases residual or recurrent disease was suspected. Conclusions: EMR is a safe and effective treatment for patients who have high grade dysplasia and T1NO tumours. In 54% of cases residual or recurrent disease was suspected. These fi gures are most likely due to the technical skills of the endoscopist and the variability of results depending on endoscopist experience. Initially multiple resection attempts were carried out to reduce the risk of complications such as oesophageal perforation. As familiarity with the EMR increased the recurrence rate of disease was signifi cantly reduced.
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