Endoscopic submucosal dissection for early esophageal cancer and precancerous lesions

Abstract

Objective To investigate the clinical effect of endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions. Methods 60 cases of early esophageal cancer and precancerous lesions were removed by ESD at our center from June, 2015 to June, 2017. Results All the 60 had successful dissection, with an average operating time of 65 min. The maximum size of the resection was 32 mm×25 mm, and the minimum 14 mm×11 mm. Eight cases had different degrees of hemorrhage; and the electrocoagulation of the thermal biopsy forceps was successfully stanched; and 2 cases of hemorrhagic mass had successful hemostasis by metal titanium clip. The scope of two cases was more than 75% of the total circumstance of their esophagus, and had difficulty swallowing three months after the operation; the gastroscope indicated the esophageal stenosis, and they were improved after endoscopic expansion. Four cases showed varying degrees of chest pain, and relieved after symptomatic treatment. No one got esophageal perforation, fever, or hematemesis. After the operation, the results showed that 30 cases had early squamous carcinoma and 30 high level intraepithelial neoplasia. They were followed up 3, 6, 12, 24 and 36 months after the operation. The follow-up rate and survival rate both were 100%. No recurrence, lymph node metastasis, and distant metastasis were found. Conclusion ESD in determining the scope of early esophageal cancer and precancerous lesions and infiltration depth on the basis of detachment, is a safe, effective and minimally invasive endoscopic treatment method. It can be used as a new kind of standard treatment for early esophageal cancer and precancerous lesions in clinic. Key words: Endoscopic submucosal dissection; Early esophageal cancer; Precancerous lesions