Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video)

Takahashi, Hiroaki; Arimura, Yoshiaki; Hosokawa, Masao; Okahara, Satoshi; Tanuma, Tokuma; Kodaira, Junichi; Kagaya, Hidetoshi; Shimizu, Yuichi; Hokari, Kaku; Tsukagoshi, Hiroyuki; Shinomura, Yasuhisa; Fujita, Masahiro

doi:10.1016/j.gie.2010.02.040

Cited by 306 publications

(268 citation statements)

References 34 publications

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“…The en bloc resection rate is greater than 90% (90 .6%-100%) [24,29,[45][46][47][48][49] . En bloc resection, meaning resection in a single piece, facilitates an accurate histological assessment and reduces the risk of recurrence.…”

Section: Outcomes Of Esophageal Esdmentioning

confidence: 95%

“…En bloc resection, meaning resection in a single piece, facilitates an accurate histological assessment and reduces the risk of recurrence. In fact, the local recurrence rate after esophageal ESD is extremely low (0%-3.1%) [24,29,[45][46][47][48][49] . In contrast, the local recurrence of SCCs after EMR was reported to be as high as 20% because en bloc resection by EMR is difficult and multiple resections are required for large lesions [17] .…”

Section: Outcomes Of Esophageal Esdmentioning

confidence: 98%

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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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Section: Outcomes Of Esophageal Esdmentioning

confidence: 95%

Section: Outcomes Of Esophageal Esdmentioning

confidence: 98%

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Honda

Akiho

2012

WJGP

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“…Bleeding during ESD can be managed by endoscopic hemostasis with soft coagulation by forceps. Even with these ESD-related incident risks taken into consideration, the merit that large lesions (i.e., superficial spreading carcinoma) can be resected en-bloc is more beneficial (6). And the number of lesions for endoscopic therapy including diagnostic treatment is increasing because of the invasiveness of surgery and chemo-radio therapy (CRT) (1).…”

Section: Introductionmentioning

confidence: 99%

Management of strictures after endoscopic submucosal dissection for superficial esophageal cancer

Kawaguchi¹,

Kurumi²,

Takeda³

et al. 2017

Ann. Transl. Med.

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Endoscopic resection of early esophageal cancer has a high therapeutic effect while being minimally invasive. Especially, the establishment of the endoscopic submucosal dissection (ESD) procedure has made it possible to resect large lesions in an en-bloc manner. As a result, accurate pathology evaluation became possible, and the risk of local recurrence was extremely low. On the other hand, esophageal strictures after endoscopic treatment of an extensive circumferential lesion are a potential problem. Previously, for the prevention and treatment of esophageal strictures, patients had to undergo painful endoscopic balloon dilation (EBD) many times. It is, however, associated with complications (perforation, bleeding, etc.). For this, oral intake and/or a local injection of steroids were given and EBD sessions were less frequently or even unnecessarily performed. Furthermore, oral mucosa epithelial cell sheet transplantation and biodegradable stents are applied for controlling post-ESD stricture. Nevertheless, EBD was still the treatment option for refractory cases of stenosis. Recently, endoscopic radial incision and cutting methods have been applied to esophageal post-procedural strictures and even for anastomotic strictures following surgery. Thus, it is now becoming possible to treat circumferential lesions with ESD and to control the resultant stenosis.

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“…In the case of superfi cial esophageal SCC aft er endoscopic treatment, Kume et al ( 19 ) reported a rate of metachronous recurrence rate of 16.4 % , and Takahashi et al ( 38 ) reported a rate of 7 % . Katada et al ( 20 ) reported a local recurrence rate of 20 % and Kume et al ( 19 ) reported a rate of 11 % .…”

Section: Esophagusmentioning

confidence: 99%

Comparison of the Long-Term Outcomes of Endoscopic Resection for Superficial Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus in Japan

Nakagawa

Koike

Iijima

et al. 2014

American Journal of Gastroenterology

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OBJECTIVES:Few studies have simultaneously evaluated the long-term outcomes of endoscopic resection (ER) for squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the esophagus in Japan. The objective of this study was to evaluate the long-term outcomes of ER for superfi cial esophageal cancer in consecutive patients. METHODS:This was a retrospective study from a single institution. From April 2001 to June 2012, 204 patients with SCC and 26 patients with AC were included from a total of 355 consecutive patients who were treated by esophageal ER at the Tohoku University Hospital. Patients with submucosal invasion deeper than 200 μ m and lymphovascular involvement were excluded. The intervention followed was endoscopic therapy. RESULTS:Overall survival, disease-free survival, and recurrence rates were evaluated as long-term outcomes. In the SCC group, during the median observation time of 36.5 months (range, 6 -120 months), 22 (10.8 % ) patients experienced metachronous recurrence, 4 (2.0 % ) patients experienced local recurrence, and 27 (13.2 % ) patients died from causes unrelated to SCC. In the AC group, during the median observation time of 45.5 months (range, 6 -131 months), one patient (3.8 % ) experienced metachronous recurrence and two (7.7 % ) died from causes unrelated to AC. The cumulative 5-year overall survival rates were not signifi cantly different between SCC (75.9 % ) and AC (88.9 % ) ( P = 0.120). The cumulative 5-year disease-free survival rates of SCC (57.1 % ) were signifi cantly lower than those of AC (85.2 % ; P = 0.017). The cumulative 5-year recurrence rates of SCC (32.0 % ) were signifi cantly higher than those of AC (4.2 % ; P = 0.023). CONCLUSIONS:The rate of recurrence after ER was higher in patients with SCC than that in patients with AC. These fi ndings suggest that, by detecting AC of the esophagus earlier, a satisfactory prognosis without recurrence can be expected after ER in Japan, and more rigorous endoscopic follow-up is necessary after ER in patients with SCC than in those with AC.

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Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video)

Cited by 306 publications

References 34 publications

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Management of strictures after endoscopic submucosal dissection for superficial esophageal cancer

Comparison of the Long-Term Outcomes of Endoscopic Resection for Superficial Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus in Japan

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