Takuji Gotoda

Application of endoscopic mucosal resection for hypopharyngeal cancer

Endoscopic mucosal resection (EMR) was applied in an 80‐year‐old Japanese man with stage I hypopharyngeal cancer because he refused further radical therapy after esophagogastrectomy for gastric and esophageal cancers. Although EMR was successfully performed without complications, histopathologic investigation revealed cancer‐positive lateral margins. Furthermore, another biopsy from the right aryepiglottic fold yielded a diagnosis of laryngeal cancer. Radiation therapy was ultimately performed because of the possibility of residual tumor and coexistent laryngeal cancer. Endoscopic mucosal resection as a curative treatment for hypopharyngeal cancer is associated with several problems that must be resolved before general application is feasible. However, the present case, at least, shows the possibility of using EMR as a diagnostic procedure and as a less invasive palliative treatment.

Indications for Endoscopic Submucosal Dissection of Early Gastric Cancers

The accepted guideline at the present time for endoscopic mucosal resection (EMR) of early gastric cancer (EGC) in an intramucosal well-differentiated adenocarcinoma 20 mm or less (≤20 mm) in diameter without ulceration. Recent advances in the endoscopic submucosal dissection (ESD) technique, however, now make it possible to resect en bloc larger intramucosal lesions as well as submucosal lesions with minute penetration ≤500 μm (SM1), so expanded criteria for endoscopic resection of EGC have been proposed as follows: (1) intramucosal well-differentiated adenocarcinoma without ulceration regardless of lesion size; (2) intramucosal well-differentiated adenocarcinoma with ulceration ≤30 mm in diameter; and (3) SM1 well-differentiated adenocarcinoma ≤30 mm in diameter. ESD has been specifically developed for the en bloc resection of larger lesions, but it is considerably different and technically more difficult than EMR. The results so far have been highly encouraging, although long-term outcome data are still unavailable.