Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms

Abstract

Background and Aim: There has been a marked increase in the number of esophageal squamous cell neoplasms (SCNs) which are applicable to local treatment by virtue of recent developments in endoscopy. Endoscopic submucosal dissection (ESD) is an effective treatment for early noninvasive gastrointestinal cancers.

Aim of this study was to evaluate efficacy of ESD for superficial esophageal squamous cell neoplasms.

Subjects & Methods: Between November 2010 and March 2012, seventy-two lesions with superficial esophageal squamous cell neoplasms, which were treated by ESD in Kumamoto University Hospital, were analyzed in this study. Therapeutic efficacy, complications, and follow-up results were assessed.

Results: Mean size of the lesions was 19±14 mm (range; 1-80 mm); and mean size of the resection specimens was 29±13 mm (range; 7- 80mm). Extensive lesions over 2/3 of the circumference were observed in 17 patients. En bloc resection rate was 100% (72/72), and en block resection rate with tumor-free lateral/basal margins was 95.8% (69/72). Perforation didn’t occur. Endoscopic dilation was performed for post-operative stenosis in 10 patients. In 3 patients who developed pinhole-like stenosis followed by circumferential ESD, combination treatment of oral steroid administration with endoscopic dilation could achieve favorable courses. None of the patients developed local recurrence or distant metastasis in the follow-up period.

Conclusion: ESD is a minimally invasive, relatively safe treatment method for esophageal SCNs. In particular, it is suggested that ESD combined with oral steroid administration and endoscopic dilation, might be applicable to the patients with circumferential SCNs where post-operative stenosis must follow circumferential ESD.