Management of strictures after endoscopic submucosal dissection for superficial esophageal cancer

Abstract

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.

Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection

“…Therefore, it is plausible that our study found a higher incidence of total esophageal stricture due to the high percentage of patients presenting with wide esophageal lesions. Overall, the results of this retrospective study indicate a number of independent risk factors for the development of esophageal stenosis following ESD, which are in line with findings of other studies [13][14][15][16][17][18][19][20][21]. Mizuta et al [13] highlighted that the primary contributor to esophageal stenosis following ESD was the area of periesophageal mucosal defect exceeding 71%.…”

Comparative study of esophagectomy, endoscopic therapy, and radiotherapy for cT1N0M0 esophageal cancer in elderly patients: A SEER database analysis

“…The proportion of patients who died of esophageal cancer was significantly higher in the RT than in the ES and ET groups. Our results are consistent with the findings of other research, suggesting that aging, T stage, and tumor differentiation are related to a poor prognosis …”

Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia

“…16,18,19 Serial endoscopic dilations remain the mainstay therapy, but steroid administration via different routes may provide some additional benefit. 19,20…”