Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Abstract

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.

Temporary Insertion of a Covered Self-Expandable Metal Stent to Treat Esophageal Perforation due to Endoscopic Submucosal Dissection

“…Corrective measures for various post-endoscopic submucosal dissection esophageal complications are currently being established (1). However, no previous reports of esophageal perforation with pyothorax due to endoscopic submucosal dissection have been published.…”

Esophageal Cancer

“…Although most centers use the fl exible fi ber-optic system, in cases with severe stricture, esophagoscopy may not be possible. In these circumstances, endoscopic esophageal ultrasound (EUS) 106 and EUS fi ne-needle aspiration (EUS-FNA) are the procedures of choice. FNA with biopsy of suspicious fi ndings is an important step during the staging process [ 4 ].…”

“…It has been shown to have similar efficacy when compared to esophagectomy [ 105 ]. EMR is limited by the size of the lesion due to the increased risk of recurrence of disease and incorrect histological evaluation associated with the piecemeal resection of larger lesions [ 106 ]. Endoscopic submucosal dissection (ESD) is common in Asia and allows removal of larger esophageal lesions en bloc.…”

Current treatment options for the management of esophageal cancer

“…A more recent development in treatment of localized superficial esophageal adenocarcinoma and squamous cell carcinoma and precursor lesions is endoscopic submucosal dissection. This technique allows for more extensive resection of larger lesions and definitive treatment of precursor lesions including Barrett’s metaplasia and squamous dysplasia 47,48. Esophagectomy is also an acceptable treatment option at any point for T1a lesions.…”