Abstract
This study reports the outcomes of endoscopic submucosal single-tunnel dissection or endoscopic submucosal multi-tunnel dissection for the treatment of esophageal neoplastic lesions of at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions. From July 2014 to February 2018, a total of 124 lesions underwent endoscopic submucosal tunnel dissection at our hospital. One to four submucosal tunnels were created in the oral to anal direction. Of the 124 lesions, there were 83 noncomplete circumferential lesions and 41 circumferential lesions. Endoscopic submucosal single-tunnel dissection was performed in 54 patients, two-tunnel dissection in 43 patients, three-tunnel dissection in 19 patients, and four-tunnel dissection in 8 patients. The mean dissection speed was 22.8 ± 12.7 mm2/min. En bloc dissection was achieved in all lesions, and the R0 resection rate was 70.2 percent. No matter how large the lesion area was, there were no significant differences in the dissection speed and the R0 resection rate when lesions were at least three-quarters of the esophageal circumference. Esophageal stricture was observed in 54 patients and was relieved by placement of a retrievable metal stent or by endoscopic water balloon dilation. No recurrence was noted after 19.1 ± 12.4 months of follow-up. Our large sample size study showed that endoscopic submucosal tunnel dissection showed effectiveness and safety for the treatment of large superficial esophageal neoplastic lesions at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions.
Highlights
Endoscopic submucosal dissection (ESD) is recommended as the preferred treatment choice for early esophageal squamous cell carcinoma, adenocarcinoma, and precancerous lesions by the Chinese Society of Digestive Endoscopy (CSDE) [1], the Japan Esophageal Society (JES) [2], and the National Comprehensive Cancer Network (NCCN) guidelines
To provide more evidence regarding the outcomes of ESSTD and endoscopic submucosal multi-tunnel dissection (ESMTD) in treating nearcircumferential and circumferential esophageal lesions, we report 124 sequential cases of large esophageal neoplastic lesions that were at least three-quarters of the esophageal circumference
Recent comparative retrospective studies revealed that endoscopic submucosal tunnel dissection (ESTD) is a safe and effective alternative for large esophageal superficial neoplasms, resulting in a shortened operative time, a higher dissection speed, and an increased radical curative rate in comparison with ESD [12, 13]
Summary
Endoscopic submucosal dissection (ESD) is recommended as the preferred treatment choice for early esophageal squamous cell carcinoma, adenocarcinoma, and precancerous lesions by the Chinese Society of Digestive Endoscopy (CSDE) [1], the Japan Esophageal Society (JES) [2], and the National Comprehensive Cancer Network (NCCN) guidelines. The less obvious lifting effect of the submucosal injection and the collapse of the submucosal space have restricted its application in large superficial esophageal neoplastic lesions. To combat these limitations of ESD, Linghu et al described the use of endoscopic submucosal tunnel dissection (ESTD) [3, 4]. The tunnel between the mucosa and muscularis propria is the core characteristic of ESTD, which is a time-saving and efficient dissection technique for large esophageal neoplastic lesions that is associated with fewer complications [4]. Some difficulties remain in the use of the single-tunnel ESTD (ESSTD) procedure for the dissection of near-circumferential or circumferential esophageal lesions. The dissection in the desired plane is difficult because of the larger and/or wider
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