Detection and treatment of an asymptomatic case of early esophageal cancer using chromoendoscopy and endoscopic mucosal resection.

Recent trends in the management of superficial esophageal cancer consist of improved detection and curative endoscopic therapy. However, successful endoscopic therapy has not been reported in Taiwanese patients with this disease. We describe the case of a male, 38-year-old habitual drinker admitted for a general health check-up, whose endoscopic examination revealed a slightly depressed discolored lesion in the middle esophagus. Chromoendoscopy with 3% Lugol's iodine solution showed a mesh-like unstained pattern occupying approximately two-thirds of the circumferential esophageal mucosa. Spraying with 2% toluidine blue solution stained a 3 x 6 cm suspect area pale blue. Endoscopic biopsy confirmed squamous cell carcinoma. Histopathologic examination revealed the lesion was a type IIc superficial esophageal cancer. Endoscopic ultrasonography showed the lesion was limited to the epithelial layer with no evidence of lymph node involvement. The lesion was removed en bloc using endoscopic mucosectomy. Microscopic examination of the resected specimen demonstrated that the depth of invasion was confined to the epithelial layer except for some areas with small nests of tumor cells within the lamina propria. Balloon dilatation to prevent post mucosectomy stricture was performed and the patient recovered uneventfully. At 1 year of follow-up, the patient was alive without any endoscopic signs of local recurrence. This case suggests that chromoendoscopy in combination with endoscopic resection is likely to benefit patients with early-stage esophageal cancer.