Endoscopy for oesophageal tumours

11 Apr 2008
Endoscopic removal of oesophageal surface tumours avoids major surgery

The removal through endoscopy of tumours that affect only the superficial layers of the oesophagus can avoid complete removal of this part of the digestive tract. The technique, carried out at the University Hospital of Navarra for the last three years, was presented at the VI International Course on Therapeutic Endoscopy in the Digestive System. Over 90% of the patients treated for this ailment at the University Hospital of Navarra have not needed further removal of the oesophagus.

400 specialists from ten different countries attended the course, focusing on the therapeutic possibilities of endoscopy in the digestive system. Treatment using digestive endoscopy, without having to carry out surgery, is increasing.

"These applications are less aggressive than surgical operations and are undertaken at out-patient clinics in about 99% of the cases, which usually enables the patient to go home after the walk-in/walk-out treatment", explained Doctor Miguel Ángel Muñoz Navas, Director of the Digestive System Service at the University Hospital of Navarra, Spain.

The tube used to perform the endoscopy contains not only a light and camera but also a duct for carrying other instruments allowing biopsies, removal of polyps, injection of fluids, coagulation of bleeding, extraction of stones and the draining of abscesses. It also carries a echoendoscope to provide detailed images of lesions.

Describing the technique, Dr Muñoz said: "The oesophagus is made up of three layers: mucous, sub-mucous and muscular. When the tumour is located in the mucous, we can take it out completely in most cases and thus avoid extirpation of the oesophagus. Until recently patients with this ailment - although affecting only the primary layers - were recommended the total extirpation of the oesophagus, which involved surgery with a high morbidity risk and even death".

He continued; "there are times when you have to operate but there are others when a solution with endoscopy can be tried. But, in this case, monitoring of the patient has to be undertaken. It could be the case that we remove a tumour with endoscopy and the anatomopathology shows up the fact that the cancer is more infiltrated than had been thought from the biopsies or the echoendoscopy. In these cases a surgical operation is required. Our experience has shown that more than 90% of patients that we have treated with this technique have not needed subsequent surgery".

Removal of oesophageal tumours using endoscopy is not a very widespread treatment, in part due to its complexity. Nevertheless, given this research, it has a real possibility for wider use and could save time, money and patient discomfort, especially given the walk-in/walk-out nature of the procedure.