Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms

doi:10.1016/j.cgh.2006.03.024

Clinical Gastroenterology and Hepatology

Volume 4, Issue 6, June 2006, Pages 688-694

https://doi.org/10.1016/j.cgh.2006.03.024 Get rights and content

Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squamous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100% (58/58), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 78% (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9%) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16%) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 31 patients fulfilling the criteria of node-negative tumors (mean follow-up, 17 months), 1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.

Section snippets

Patients and Methods

Fifty-eight consecutive superficial esophageal SCNs occurring in 43 patients were resected by ESD between January 2002 and September 2005 at the University of Tokyo Hospital, Tokyo, Japan. All patients with esophageal neoplasm who had a preoperative diagnosis of high-grade intraepithelial neoplasm (high-grade dysplasia and noninvasive carcinoma) or intramucosal invasive carcinoma were candidates for ESD. Diagnosis was made by using chromoendoscopy with iodine staining, endoscopic biopsy, and

Results

The clinicopathologic features of the included patients are shown in Table 1. All the lesions were resected in an en bloc fashion. En bloc resection with tumor-free lateral/basal margins (R0 resection) was accomplished in 45 of the 58 dissected lesions (78%) (Table 2). The mean resection size was 38 mm (range, 11–72 mm), and the mean lesion size was 24 mm (range, 2–66 mm). The small lesions for which conventional EMR seemed to be applicable in terms of lesion size were treated by ESD because of

Discussion

To show the efficacy of the ESD procedure for esophageal SCNs, 2 aspects, the technical feasibility of the procedure and follow-up data showing the efficacy of the procedure, have to be considered. Although the duration of follow-up is short, the present study shows that no patient with esophageal SCNs that met the criteria of node-negative tumors postoperatively treated with ESD experienced recurrence extraluminally. One noninvasive carcinoma with Rx (lateral) resection recurred locally in the

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To date, western data on colorectal ESD are limited. This study aimed to assess the efficacy and safety of rectal ESD for superficial lesions ≥ 8 cm.
A total of 138 superficial rectal neoplasms treated by ESD were allocated in two groups: 25 in the “giant” ESD group and 113 in the control group.
En bloc resection was achieved in 96% of cases in both groups. En bloc R0 resection rate was similar between the “giant” ESD group and the control group (84% vs 86%; p: 0.5) and curative resection was higher in the control group (81%) than in “giant” ESD group (68%) without reaching statistical significance (p: 0.2). Dissection time was significantly longer in the “giant” ESD group (251 vs 108 min; p <0.001), however, dissection speed was significantly higher (0.35 vs 0.17 cm2/min; p: 0.02).). Post-ESD stenosis was observed in 2 patients from the “giant” ESD group (8% vs 0% of control group, p: 0.03). No significant differences were found in delayed bleeding, perforation, local recurrences, and need for additional surgery.
ESD for superficial rectal tumors ≥ 8 cm is a feasible, safe, and effective therapeutic option.
Effect of particle size on the tissue adhesion and particle floatation of a colloidal wound dressing for endoscopic treatments
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Endoscopic submucosal dissection (ESD) is a minimally invasive technique that is widely used to remove gastrointestinal tumors. However, because the walls of the duodenum and large intestine are thin, perforation can easily occur after ESD. We have previously reported that alkyl group-modified Alaska pollock gelatin-based microparticles (C10Ps) formed a colloidal gel that could adhere to defects and close perforations, driven by hydrophobic interactions. The present study focused on the effect of particle size on the colloidal gel properties and the floatation of C10Ps in the air in the delivery of C10Ps. We prepared C10Ps with different particle sizes from 0.1 to 100 µm. The storage modulus and adhesion strength of the C10P colloidal gel increased with decreasing particle size. All the C10Ps formed a colloidal gel layer on duodenum tissue after being sprayed from an endoscopic device. The underwater stability and burst strength of C10Ps with a particle size of 0.1 and 1 µm were higher than for larger C10Ps. Floating of the small-sized C10Ps in the air was observed. The results indicated that C10Ps with a size of 1 µm had suitable properties for use in endoscopic treatments.
We previously reported tissue adhesive microparticles as a spray-deliverable wound dressing in gastrointestinal tissues. However, their functions depending on particle size have not yet been clarified. In the present study, we prepared decyl group-modified Alaska pollock gelatin nano and microparticles (C10Ps) with different particle sizes from 0.1 to 100 µm and evaluated the effect of particle size on the colloidal gel properties (rheological property, underwater stability and perforation-closing ability) and the floatation of C10Ps in the air in the delivery of C10Ps.
Clinical outcomes of endoscopic submucosal dissection for superficial circumferential esophageal squamous cell carcinoma
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Our aim was to elucidate the clinical outcomes of endoscopic submucosal dissection (ESD) for superficial circumferential esophageal squamous cell carcinoma (cESCC).
Consecutive patients who underwent ESD for cESCC between 2009 and 2020 were retrospectively reviewed. Short-term outcomes were en-bloc resection, R0 resection, procedure time, and adverse events, whereas long-term outcomes were overall survival (OS), disease-specific survival (DSS), cumulative recurrence rate (CRR), and clinical course.
Fifty-two patients with 52 cESCCs (median tumor length, 5.0 cm; interquartile range [IQR], 4.0-6.3) were evaluated. The en-bloc resection and R0 resection rates were 100% (95% confidence interval [CI], 94.4-100) and 69.2% (95% CI, 54.9-81.3), respectively. The median procedure time was 112 minutes (IQR, 87-162). Intraoperative perforations and delayed bleeding occurred in 4 (7.7%) and 1 (1.9%) patients, respectively. Among the 42 patients who underwent ESD alone, 36 (85.7%) experienced esophageal strictures. Within a median follow-up of 49.1 months (IQR, 25.7-74.7), the 4-year OS, DSS, and CRR were 86.2% (95% CI, 71.6-93.6), 95.5% (95% CI, 83.1-98.9), and 11.5% (95% CI, 4.1-23.1), respectively. There was no significant difference in the OS between patients with low-risk cESCC (pT1a, negative lymphovascular invasion, and negative vertical margin) and high-risk lesions, regardless of undergoing additional treatment (P = .93). In 31 patients with low-risk cESCC who were treated with ESD alone, the 4-year OS, DSS, and CRR were 93.2%, 100%, and 0%, respectively.
ESD is a highly curative treatment for cESCC with favorable long-term outcomes, especially in low-risk patients. Stricture-prevention techniques should be improved to optimize the benefits of ESD for cESCC.
Self-expandable metallic stents may be more efficient than balloon dilatation alone for esophageal stricture after circumferential endoscopic submucosal dissection: a retrospective cohort study in China
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An Ailment with Which I Will Contend: A Narrative Review of 5000 Years of Esophagogastric Cancers and Their Treatments, with Special Emphasis on Recent Advances in Immunotherapeutics
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Original articleEndoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms

Section snippets

Patients and Methods

Results

Discussion

Gastrointest Endosc

Gastrointest Endosc

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

Gastrointest Endosc

Gastrointest Endosc

In situ carcinoma of the esophagusmacroscopic study with particular reference to the Lugol test

Endoscopy

How can we diagnose the early stage of esophageal cancer?Endoscopic diagnosis

Endoscopy

Endoscopic mucosal resection for early esophageal cancer. Indication and techniques

Dig Endosc

Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus

Cancer

Superficial esophageal carcinoma. Surgical treatment and the results

Cancer

Surgery for cancer of the esophagus

Semin Oncol

Optimum treatment strategy for superficial esophageal cancerendoscopic mucosal resection versus radical esophagectomy

World J Surg

Mucosal squamous cell carcinoma of the esophagusa clinicopathologic study of 30 cases

Oncology

Original article
Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms