Endoscopy 2006; 38(7): 690-695
DOI: 10.1055/s-2006-925255
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 french endoscopy centers

J.  Dubuc1 , J.-L.  Legoux1 , M.  Winnock2 , J.-A.  Seyrig3 , J.-P.  Barbier4 , T.  Barrioz5 , R.  Laugier6 , G.  Boulay7 , D.  Grasset8 , D.  Sautereau9 , D.  Grigoresco10 , J.  Butel11 , J.-Y.  Scoazec12 , T.  Ponchon13
  • 1 Hepatogastroenterology Department, Haut Leveque Hospital, Bordeaux University Hospital, Pessac, France
  • 2 INSERM U593, Bordeaux 2 University, Bordeaux, France
  • 3 Hepatogastroenterology Department, General Hospital, Pontivy, France
  • 4 Hepatogastroenterology Department, Georges Pompidou European University Hospital, Paris, France
  • 5 Hepatogastroenterology Department, University Hospital, Poitiers, France
  • 6 Hepatogastroenterology Department, La Timone University Hospital, Marseille, France
  • 7 Hepatogastroenterology Department, Jean Imbert General Hospital, Arles, France
  • 8 Internal Medicine and Hepatogastroenterology Department, General Hospital, Montauban, France
  • 9 Hepatogastroenterology Department, University Hospital, Limoges, France
  • 10 Hepatogastroenterology Department, Dr. Emile Roux General Hospital, Le Puy En Velay, France
  • 11 Hepatogastroenterology Department, General Hospital, Abbeville, France
  • 12 Anatomopathology Department, Edouard Herriot University Hospital, Lyon, France
  • 13 Hepatogastroenterology Department, Edouard Herriot University Hospital, Lyon, France
Weitere Informationen

Publikationsverlauf

Submitted 19 December 2005

Accepted after revision 22 January 2006

Publikationsdatum:
11. Mai 2006 (online)

Background and Study Aims: The prevalence of esophageal squamous-cell carcinoma in high-risk patients and the advantages of systematic Lugol staining during esophagoscopy have not yet been evaluated in a large prospective study. In this study we aimed to assess the prevalence of this type of tumor in high-risk patients, to examine the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma, and to establish whether it is possible to identify a particularly high-risk group which would benefit from systematic screening.
Patients and Methods: A prospective study was undertaken in 62 endoscopy centers. A total of 1095 patients were enrolled, none of whom had any esophageal symptoms. These patients had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma (group 1), with alcoholic chronic pancreatitis (group 2), with alcoholic cirrhosis (group 3), or were alcohol and tobacco addicts (group 4). The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining.
Results: The prevalence of esophageal squamous-cell carcinoma was 3.2 %. The group 1 patients showed the highest prevalence of carcinoma (5.3 %) and the highest prevalence of dysplasia (4.5 %). Of the 35 carcinomas detected in the 1095 patients, seven (20 %) were early lesions, and 20 % were only detected after Lugol staining (P = 0.02). High-grade dysplasia was only observed in group 1 patients and two-thirds of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2.4 %, and 77 % of these were detected only after Lugol staining (P < 0.001).
Conclusions: Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer. The prevalence of dysplasia and cancer reached 9.9 % in group 1, and we therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.

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J.-L. Legoux, M. D.

Hepatogastroenterology Department

Haut Leveque Hospital · Bordeaux University Hospital · 33604 Pessac · France

Fax: +33-557656445

eMail: Jean-louis.legoux@chu-bordeaux.fr