Endoscopic Submucosal Dissection With Circumferential Incision Versus Tunneling Method for Treatment of Superficial Esophageal Cancer

Abstract

BACKGROUND: Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence. OBJECTIVE: We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T). METHODS: Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events. RESULTS: A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001). CONCLUSION: ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms.

Management of esophageal neoplasms by endoscopic submucosal dissection: experience over 100 consecutive procedures

“…We hypothesized that after accomplishing the learning curve period and with accumulated experience, we have admitted for ESD more challenging cases and larger tumor lesions with higher rates of submucosal invasion or lymphovascular compromise, which ultimately resulted in a non-curative intervention despite complete tumor removal. The compilation of our cumulative data shows that in the West, rates of clinical efficacy and complications associated with esophageal ESD can be achieved in a similar proportion to those reported in Asian studies, [22][23][24][25] with a significant improvement over time after further accumulating experience with the method. [26][27][28][29] Table 4 presents a comparative analysis of our results in terms of esophageal ESD clinical effectiveness in different published case series.…”

“…The expansion of ESD in the Latin America is crucial to increase the en bloc resection rate of esophageal tumors regardless of their size, allowing precise histological assessment and reliable staging. [17][18][19][20][21][22][23][24][25][26][27][28][29] The aim of our research was to present the results of a large series of patients with early esophageal neoplasms managed by ESD by a single trained operator and to compare the clinical outcomes of the patients with those obtained at Japanese endoscopic centers.…”

Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection: Progress, Techniques, and New Directions

“…Also scopic submucosal dissection with circumferential incision (ESD-C) versus tunneling method for treatment (ESD-T) of superficial esophageal cancer (9) . The first technique is performed through an incision along the oral margins and next at the caudal margin of the lesion, resulting in a C-shaped incision.…”