Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Esophageal Dysplasia and Carcinoma

Inoue, Haruhiro; Minami, Hitomi; Kaga, Makoto; Sato, Yoshitaka; Kudo, Shin‐ei

doi:10.1016/j.giec.2009.08.005

Cited by 70 publications

(53 citation statements)

References 16 publications

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“…However, it should be noted that ESD is technically difficult even if the frequency of complications, such as perforation, decreases due to the improvement of devices and techniques (19)(20)(21). Fortunately, ESD was performed safely in all the patients without serious complications with a good complete resection rate of 79% in this study.…”

Section: Discussionmentioning

confidence: 61%

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

et al. 2015

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Objective The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. Methods The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. Results Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapsefree survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. Conclusion Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ! submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.

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Section: Discussionmentioning

confidence: 61%

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

et al. 2015

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“…Common self-limited adverse events of EMR include chest pain, abdominal pain, dysphagia, odynophagia, and dyspepsia. 143 The overall incidence of serious adverse events such as bleeding, perforation, and stricture has been estimated to be between 0.5% and 5%. 144 Bleeding occurs more often with multifocal EMR and with EMR of gastric lesions.…”

Section: Adverse Events Of Percutaneous Endoscopic Enteral Accessmentioning

confidence: 99%

“…144 Bleeding occurs more often with multifocal EMR and with EMR of gastric lesions. [143][144][145] Perforation with gastric EMR is reported more frequently than with esophageal EMR, possibly because of the larger lesions encountered in the stomach. 146 Stricture formation is mostly reported after esophageal EMR, especially when circumferential resection is performed.…”

Section: Adverse Events Of Percutaneous Endoscopic Enteral Accessmentioning

confidence: 99%

Adverse events of upper GI endoscopy

Ben–Menachem¹,

Decker²,

Early³

et al. 2012

Gastrointestinal Endoscopy

304

170

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“…By mixing in a small amount of dye, the sodium hyaluronate can be easily distinguished from the non-injected area; (3) mucosal incision: a mucosal incision around the lesion is then made with an electrosurgical knife. Several knives have been developed for this purpose, such as the insulation-tip knife [34,35] , hook knife [24,36] , flex knife [37,38] , flush knife [39] , ball-tipped flush knife [40] and triangle-tipped knife [41] . Usually, the distal half of the mucosal incision is completed first, followed by the proximal half; and (4) submucosal dissection: dissection of the submucosa proceeds from the proximal to the distal end, using the same knife that was used for the mucosal incision.…”

Section: Esophageal Esd Proceduresmentioning

confidence: 99%

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Honda

Akiho

2012

WJGP

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Endoscopic resection is an effective treatment for noninvasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation.Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

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Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Esophageal Dysplasia and Carcinoma

Cited by 70 publications

References 16 publications

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

Adverse events of upper GI endoscopy

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

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