OBJECTIVETo evaluate the long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions.

METHODSOne-hundred and seventy-one cases with early esophageal cancer (intramucosal carcinoma) and precancerous lesions were treated by APC from 1994 to 2005, and all the cases were followed up. One-hundred and sixty-eight (98.2%) cases were follow-up by endoscopic examination for several times. On average, each patient was endoscopically examined 2.8 times. The follow-up rate was 100%.

RESULTSThe precancerous lesion group had 160 patients. They were followed up for 5 years. 11 patients died of causes unrelated to cancer. The lesions developed into esophageal squamous cell carcinoma in five patients ( 2 died and 3 underwent esophagectomy). The remaining 144 cases survived without cancer. In this group, the esophageal cancer incidence rate is only 3.1% (5/160). The early cancer (i.e. intramucosal cancer) group had 11 patients. During the 5-year follow-up period, two patients died of causes unrelated to cancer,six patients had recurrence (4 patients died and 2 patients underwent esophagectomy), and only 3 patients survived without cancer. Therefore, the 5-year survival rate was only 27.3% (3/11).

CONCLUSIONSThe APC therapy for precancerous lesions of the esophagus is effective and successful. Indications should be carefully considered when treating early esophageal cancer such as intramucosal carcinoma by APC therapy.

Argon Plasma Coagulation ; methods ; statistics & numerical data ; Carcinoma, Squamous Cell ; surgery ; Endoscopy ; Esophageal Neoplasms ; surgery ; Esophagoscopy ; Follow-Up Studies ; Humans ; Precancerous Conditions ; surgery ; Survival Rate

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.
Adult ; Combined Modality Therapy/methods/statistics & numerical data ; Democratic People's Republic of Korea/epidemiology ; Esophageal and Gastric Varices/*embryology/*surgery ; Esophagoscopy/statistics & numerical data ; Feasibility Studies ; Female ; Hepatitis B/*epidemiology/*prevention & control ; Hepatitis B Vaccines/*administration & dosage ; Humans ; Male ; Mass Vaccination/*statistics & numerical data ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; Secondary Prevention/methods/statistics & numerical data ; Treatment Outcome

OBJECTIVETo investigate the prevalence of esophageal and gastric cardia cancer and various precancerous lesions in high-risk rural areas.

METHODSRandom cluster sampling method was used to select people aged 40-69 years of some natural villages as screening objects in Feicheng, Shangdong province, from 2006 to 2012. The screening program was conducted by endoscopy with iodine staining and indicative biopsy followed by pathological examination.

RESULTSA total of 24 759 subjects were screened during 2006-2012 years. The positive detection rates of esophagus and gastric cardia cancers were 1.37% and 0.42%, respectively, the early diagnosis rates were 84.71% and 65.05%, and the treatment rates were 92.65% and 92.23%, respectively. The detection rates of all lesions in males were significantly higher than those in females (P < 0.05), and were gradually increased with age (P < 0.05). The time trend analysis showed that detection rates of all lesions in the two sites showed no significant changes during this period, and the detection rates of esophageal lesions were higher than those of gastric cardia.

CONCLUSIONSThere are considerable numbers of patients with precancerous lesions in the general population from the high risk areas. Men and the elderly are the key populations calling for cancer control programs. Endoscopy using iodine staining is an effective method to increase the detection rate of precancerous lesions and cancers. The root of mucosal fold in gastric cardia must be carefully observed so as to increase the detection rate of early gastric cardia lesions.

Adult ; Aged ; Biopsy ; Carcinoma, Squamous Cell ; Cardia ; Coloring Agents ; Early Detection of Cancer ; statistics & numerical data ; Esophageal Neoplasms ; diagnosis ; epidemiology ; Esophagoscopy ; Female ; Gastroscopy ; Humans ; Iodine ; Male ; Middle Aged ; Precancerous Conditions ; diagnosis ; epidemiology ; Prevalence ; Rural Population ; statistics & numerical data ; Sex Distribution ; Stomach Neoplasms ; diagnosis ; epidemiology