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 lesionswere 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.
展开▼
