Sa1327 ESOPHAGEAL ESD FOR EARLY ESOPHAGEAL CANCERS - BEGINNER'S EXPERIENCE FROM INDIA

Abstract

Endoscopic resection (ER) for early esophageal squamous cell neoplasms (ESCN) is the standard of care. Endoscopic Sub-mucosal Dissection (ESD) for early ESCN is very rare in India. Here we would like to share our experience of ER for ESCN from a regional cancer instiutute in south india. To present the risk factors, clinical details and procedure details of ESD done for various ESCN cases from our institute. During screening endoscopies [n=4196] for naive and treated Head and Neck cancers, using image enhanced endoscopy, we diagnosed 48 early esophageal esophageal squamous cell neoplasm lesions [August 2018 - November 2019]. Among them, ESD done for fourteen cases. All were males. Mean age 57.5 years. Treated Oropharynx cancer as a primary tumour in five, Cheek cancer in four, Tonsillar cancer in one, Laryngeal cancer in one and Hypopharyngeal cancer in three. All of them were smokers. Twelve of them were reformed alcohol consumers. Out of fourteen ESDs, one was of full circumference [associated with diverticulum], four were >3/4 circumference, five were semicircumference [1/2] and four were1/3 circumference resections. Mean length of the resected specimen was 28.7 mm. Intralesional Triamcinolone injection into the resected surface was given in all the cases. Mean duration of procedure was 169.25 minutes. Oral diet started after doing gastrograffin study in initial five cases. Mean time to start oral diet was 51 hours. Achieved R0 resection in all cases. Mean followup 9 months. Most common intraprocedural complications were bleeding and injury to circular muscle. Early complication of Pnuemothorax noted in one case. ICD insertion done and improved. Late complications observed were stricture formation in one case, which required two sessions of dilatation. Endoscopic management (ER) for early esopahgeal cancer from India is a reasonably newer method of treatment in this part of the country. Hence we want to share our initial experience. ESD reduces patient morbidity, hospital stay and the time to resume diet sigificantly comparing to esophagectomy.Endoscopic image after 6 months of circumferential ESDView Large Image Figure ViewerDownload Hi-res image Download (PPT)