Abstract :
Background: Esophageal squamous cell carcinoma (ESCC) is one of important leading cancers in
Asia. In symptomatic patients, majority are detected at advanced stages because of the lack of an appropriate
surveillance protocol. Therefore, performing a surveillance endoscopy in high risk population such as patients with
a history of ENT related squamous cell carcinoma (SCC) may be appropriate. Flexible Spectral Imaging Color
Enhancement (FICE) has been reported to increase the detection rate of subtle vascular-pattern changes in many
other GI neoplasms, however only a few reports of early ESCC detection by FICE are available.
Objective: To evaluate the sensitivity and detection rate of white light endoscopy (WLE) and WLE plus
FICE for the detection of early ESCC and high grade intraepithelial neoplasia (HGIN) in previous history of ENT
related SCC patients.
Methods: Between October 2011 and February 2013 at the King Chulalongkorn Memorial Hospital,
Bangkok, Thailand, 77 patients with previous ENT related SCC underwent a surveillance EGD by WLE, followed
by a dual mode of WLE and FICE endoscopy. Approximately, seventy percent of the patients were previous or
current smokers. Demarcated red, elevated or depressed or irregular lesions detected by WLE plus mucosal color
changing and dilated with irregularity of intraepithelial papillary loops (IPCLs) were interpreted as possible esophageal
neoplastic lesions. Magnifying endoscopy (x50 and x100) under both WLE and FICE were used to further
characterize lesions. Esophageal biopsy was performed from all suspicious areas and histopathology results were
referred as our gold standard for ESCC diagnosis. In every patient, one control biopsy was taken from WLE and
FICE negative area preferably mid esophagus.
Results: There were 61 men and 16 women with a mean age of 56 years (28-74 years). The mean
interval time from the diagnosis of ENT related SCC to this surveillance was 55 months (8-234 months). The mean
durations for WLE and dual WLE /FICE examinations were 3 minutes and 10 minutes, respectively. There were 5
abnormal lesions detected in 4 patients. Of those, the histological readings showed three ESCCs and two HGINs.
FICE was able to detect all 5 lesions whereas WLE missed one early ESCC. The sensitivity for the detection of
ESCC and HGIN by WLE was lower than that of dual WLE/FICE (60% vs 100%). The overall prevalence of early
ESCC and high grade dysplasia in patients with previous history of ENT related SCC undergoing for endoscopic
surveillance in this study was 5.2%.
Conclusion: A surveillance program for early ESCC and HGD in patients with history of ENT related
SCC is justified. FICE with magnification can increase the number of positive detection.
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file/Thai-Journal-of-gastroenterology-vol-14-no-2-2365209.pdf