Multi‐institutional questionnaire on treatment strategies for superficial entire circumferential esophageal squamous cell carcinoma

Abstract

Objectives Recent innovations in prophylactic treatment with steroids have overcome the issue of esophageal stricture after endoscopic submucosal dissection (ESD), except in entire circumferential esophageal squamous cell carcinoma (EC‐ESCC). Current Japanese guidelines weakly recommend performing ESD for clinical epithelial/lamina propria EC‐ESCC with a longitudinal extension <50 mm upon implementing prophylactic treatment against stricture. However, the accurate indications for ESD in EC‐ESCC remain unknown, and strategies differ among institutions. The aim of this study was to understand the initial treatment strategy for EC‐ESCC and prophylactic treatment after ESD against esophageal stricture. Methods A questionnaire survey was conducted across 16 Japanese high‐volume centers on the initial treatment for EC‐ESCC according to the invasion depth and longitudinal extension, and prophylactic treatment against stricture. Results ESD was performed as the initial treatment not only in clinical epithelial/lamina propria lesions <50 mm (88–94% of institutions), but also in clinical epithelial/lamina propria ≥50 mm (44–50% of institutions) and clinical muscularis mucosae/SM1 (submucosal invasion depth invasion within 200 μm) lesions <50 mm (56–75% of institutions). Regarding prophylactic treatment against esophageal stricture, although there was a common point of local steroid injection, the details and administration of other treatments varied among institutions. Conclusions As ESD was performed with expanded indications for EC‐ESCC than those recommended by the guidelines in more than half of the institutions, the validity of ESD for expanded EC‐ESCC needs to be clarified. For that, it is necessary to prospectively collect short‐ and long‐term outcomes after ESD and other treatments, including esophagectomy or chemoradiotherapy.

A novel risk score model of esophageal stricture for patients undergoing endoscopic submucosal dissection

“…Many studies have identified longitudinal resection length as an independent risk factor for postoperative stricture and multivariate analysis in our study showed similar results [19,20]. we found that length was positively correlated with circumferential (r = 0.2297, P < 0.0001).…”

Endoskopische Submukosadissektion (ESD): Indikation, Techniken und Ergebnisse

“…Die aktuelle japanische Leitlinie empfiehlt für zirkumferenzielle Läsionen JES Typ B1 mit einer maximalen Längenausdehnung von > 5 cm eine chirurgische Resektion oder Radiochemotherapie [16]. In einer aktuellen Publikation gab mehr als die Hälfte der befragten Zentren an, regelmäßig zirkumferenzielle Resektionen jenseits dieser Leitlinienkriterien durchzuführen [21]. Die ESD im Ösophagus wird auch in westlichen Zentren mit hohen En-bloc-und R0-Resektionsraten komplikationsarm durchgeführt [22,23].…”