Ten-year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center

Abstract

Background/AimsEndoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN.MethodsPatients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated.ResultsESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range, 44 to 86), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range, 5 to 85) and median procedure time was 45 minutes (range, 9 to 160). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range, 18 to 62), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively.ConclusionsESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

“…In particular, stricture is a major concern that is associated with impaired patient's quality of life. The reported incidence rate of post‐endoscopic mucosal resection (EMR) or post‐ESD esophageal strictures is 6.5%‐16.7% . Furthermore, recent studies have reported that resection margins extending into >75% of the entire esophageal circumference, a histological invasion depth of M2, and mucosal defect >30 mm in longitudinal length were independent risk factors for post‐ESD stricture .…”

“…Furthermore, recent studies have reported that resection margins extending into >75% of the entire esophageal circumference, a histological invasion depth of M2, and mucosal defect >30 mm in longitudinal length were independent risk factors for post‐ESD stricture . The rate of esophageal stricture has been reported to be as high as 45.5%‐92% in patients with a mucosal defect affecting >75% of the esophageal circumference . Typically, an endoscopic balloon dilatation (EBD) is performed both to treat and prevent esophageal strictures.…”

“…In recent years endoscopic submucosal dissection (ESD) has been used as an alternative to esophagectomy in the curative treatment of superficial esophageal neoplasms (SEN). ESD is a minimally invasive procedure and has a remarkable 5‐year survival rate of 85%‐100% for patients with SEN …”

“…However, major complications associated with endoscopic treatment, such as bleeding, perforation, and stricture, have been reported. In particular, post‐ESD esophageal strictures occur in 45.5%‐92% of the patients presented with a mucosal defect affecting >75% of the circumference of the esophagus, resulted in significant deterioration in their quality of life . In addition, post‐ESD dysphagia is associated with not only mechanical strictures but also esophageal dysmotility, and several studies have reported the development of dysphagia in the absence of endoscopic stricture .…”

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

“…In cases showing tumor invasion to the muscularis mucosa (m3) or the submucosa < 200 μm from the muscularis mucosa (sm1), ER should be decided based on the risk of lymph node metastasis because the incidence of lymph node metastasis is known to be associated with the depth of invasion [23,31]. There have been efforts to expand the indications for ESD, based on reported favorable outcomes of ER for m3 or sm1 tumors [11,32,33]. One study recommended ER when the SEN had a size less than 25 mm, a lamina propria invasion width of less than 2,500 μm, and no evidence of lymphatic invasion [33].…”