Endoscopic band ligation without resection in selected patients for small and superficial upper gastrointestinal tract lesions.
2016
Background and aim: The aim of this study was to evaluate
the efficacy of endoscopic band ligation (EBL) in carefully selected
patients who would benefit from this method of resection.
Methods: Patients with early upper gastrointestinal and
small (< 15 mm) lesions treated with EBL (Duette® Multi-Band
Mucosectomy) were prospectively recruited and retrospectively
analyzed between 2010 and 2015. All cases were discussed in
a multidisciplinary cancer committee and it was concluded that,
owing to patient conditions, surgery was not possible and that not
conducting histology would not change the clinical management.
A first endoscopic control with biopsies was planned at 4-8 weeks.
If there was no persistence of the lesion, new controls were
programmed at 6 and 12 months.
Results: The group (n = 12) included 5 esophagus lesions
(adenosquamous carcinoma, n = 1; carcinoma squamous, n = 2;
adenocarcinoma, n = 2); 4 gastric lesions (high grade dysplasia,
n = 1; adenocarcinoma, n = 2; neuroendocrine tumor [NET],
n = 1), and 3 duodenal lesions (NETs) (n = 3). The mean tumor
diameter was 9.6 ± 2.8 mm (range 4-15). Only one minor adverse
event was described. At first follow-up (4-8 weeks), there was 91.6%
and 75% of endoscopic and histological remission, respectively. At
6-month follow-up there was 70% of both endoscopic remission
and negative biopsies. And at 12 months, there was 100% and 75%
of endoscopic and histological remission, respectively. Persisting
lesions were T1 cancers. The median follow-up was 30.6 months.
Conclusion: EBL without resection is an easy and safe
technique that should be considered in patients with multiple
morbidities and small superficial UGI lesions.
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