Esophageal Endoscopic Submucosal Dissection Research Articles

Treating delayed perforation after esophageal endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue.

Delayed perforation after esophageal endoscopic submucosal dissection (ESD) is rare but can be a serious complication and may require surgical treatment [1]. Recently, polyglycolic acid (PGA) sheets have been used as conservative treatment for delayed perforation after ESD in the stomach [2] [3] and colon [4].

Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study.

Preventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference. Of the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins. The occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145, P = 0.000), oral steroids (56.3%, 9/16, P = 0.011) and TA injection (50%, 10/20, P = 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21, P = 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P = 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six. Statins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.

Utility of a super-soft hood for esophageal endoscopic submucosal dissection below an esophageal stricture.

Video 1Use of a super-soft hood (Space Adjuster; TOP, Tokyo, Japan) for esophageal endoscopic submucosal dissection below an esophageal stricture.

Long‑term prognosis and comprehensive endoscopic treatment strategy for esophageal cancer, including salvage endoscopic treatment after chemoradiation therapy.

Endoscopic submucosal dissection (ESD) is the first treatment option for superficial squamous cell carcinoma of the esophagus (SSCE). Salvage endoscopic treatment for recurrent advanced esophageal cancer after chemoradiotherapy (CRT) has been reported. However, there are few reports on long-term prognosis after salvage endoscopic treatment in Japan. The present study investigated long-term treatment results after conventional ESD for SSCE and after salvage endoscopic treatment for locally recurrent lesions after CRT. Outcomes of esophageal ESD were retrospectively investigated at Nagasaki University Hospital and long-term prognosis after salvage endoscopic treatment for locally recurrence lesions after CRT was examined. The en-bloc curative resection rate was 89.5% (606/676) for conventional ESD. The 5-year cause-specific survival rate (CSS) was 98.5%. A total of 77 patients underwent salvage endoscopic treatment [ESD or photodynamic therapy (PDT)] for locally recurrent lesions after CRT. The 3-year CSS was 81.3 and 77.1% for salvage ESD and salvage PDT, respectively. SSCE management using ESD yielded high en-bloc curative resection and survival rates. Overall, establishing salvage endoscopic treatment made long-term control of the underlying disease possible, while also maintaining the quality of life for patients with recurrent advanced esophageal cancer deeper than patients with T1b who underwent CRT and patients with recurrence after additional CRT following ESD.

Prospective Evaluation of a Standardized Approach to Improve Procedure Speed in Esophageal Endoscopic Submucosal Dissection

<h2>ABSTRACT</h2><h3>Background and Aims</h3> Endoscopic Submucosal Dissection (ESD) of esophageal lesions is limited by lengthy procedure time, technique's complexity, and specialized training. We propose a standardized esophageal ESD technique that makes benefit of specimen self-retraction to improve visualization and procedure speed by starting margins' incision at the anal side followed by laterals and the proximal. <h3>Methods</h3> This is a prospective clinical trial of all consecutive patients who underwent a standardized esophageal ESD of esophageal lesions at a single tertiary referral center between December 2016 and January 2021. Primary outcome was the entire procedure speed calculated as cm²/hour. Secondary outcomes included the rates of en bloc resection, R0 resection, and adverse events. Linear regression analysis was conducted to test the association between the entire procedure speed and tumor location, number of knives used, year of procedure and pathology results. <h3>Results</h3> Thirty-two patients prospectively enrolled in our study. Mean patient age was 65±10.9 years. Mean specimen surface area was 17.9±12.7 cm². Mean entire procedure speed was 11±5.9 cm²/hr. Mean total procedure time was 93.5±31 minutes. The entire procedure speed was significantly faster with procedures performed over the last 3 years [+5.86 cm²/hr, P=0.003] or Barrett's Esophagus [+7.77 cm²/hr, P=0.001]. En-bloc and R0 resection rates were 100% and 68.8%, respectively. There were only 2 early bleeding events (6.3%) and 4 strictures formation (12.5%). All adverse events were successfully managed endoscopically. <h3>Conclusion</h3> Our standardized esophageal ESD technique offered our operator remarkable entire procedure speed with continuous annual improvement and acceptable safety profile. Future controlled multicenter studies are warranted to confirm results generalizability and help promote wider adoption of esophageal ESD. [ClinicalTrials.gov identifier: NCT04547881]

Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from asystematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation. However, the use of general anaesthesia (GA) has been hypothesised to improve ESD outcomes. We performed a systematic review and meta-analysis to compare GA against sedation in ESD. A systematic literature search was performed on Cochrane Library, EMBASE and MEDLINE using the terms "General Anaesthesia", "Sedation" and "Endoscopic submucosal dissection". Original articles comparing GA versus sedation in ESD were included. The risk of bias and level of evidence were assessed by validated methods. This review is registered in PROSPERO (CRD42021275813). 176 articles were found in the initial literature search, and 7 articles (comprising 518 patients receiving GA and 495 receiving sedation) were included. Compared with sedation, GA was associated with higher en-bloc resection rates in oesophageal ESD (RR 1.05; 95% CI: 1.00-1.10; I 2 = 65%; P = 0.05). GA patients also trended towards lower rates of gastrointestinal perforation in all ESD procedures (RR 0.62; 95% CI: 0.21-1.82; I 2 = 52%; P = 0.06). Rates of intra- procedural desaturation and post-procedural aspiration pneumonia were lower in GA patients than in patients under sedation. The included studies had a moderate to high risk of bias, and the overall level of evidence was low. GA appears safe and feasible for ESD, yet high-quality trials will be required before GA can be regularly implemented for ESD.

Water pressure method combined with magnifying endoscopy for esophageal endoscopic submucosal dissection.

Poor visual field and limited submucosal space could obstruct endoscopic submucosal dissection (ESD) and increase the risk of complications. In this manuscript, we presented ESD assisted by water pressure method and magnifying endoscopy for a difficult case of early esophageal cancer.

Prevention and management of esophageal stricture after esophageal ESD: 10 years of experience in a single medical center

Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure to deal with local early esophageal neoplasm, although post-ESD esophageal stricture is a major delayed complication of esophageal ESD greatly influencing the patient's quality of life. This retrospective study was conducted to analyze the esophageal stricture after esophageal ESD while determining further treatment and outcome of stricture management. From 2009 to 2021, we reviewed all patients who underwent ESD for esophageal squamous cell neoplasia in Kaohsiung Medical University Hospital. Totally, 133 patients with esophageal squamous cell neoplasm were enrolled. Among these 133 patients, 108 patients had lesions less than three-fourths in circumferential and 25 patients had lesions in excess of three-fourths circumferentially. Totally, 18 patients (13.5%) had symptomatic esophageal stricture and 17 patients (94.4%) had stricture existing over the upper or middle esophagus. The most important risk factor of esophageal stricture was the extent of resection of esophageal circumference, especially whole circumferential resection. Although oral steroid prevention medication was prescribed for high-risk patients with lesions more than three-fourth circumferential ESD, the stricture rate was still up to 40% (10/25). Endoscopic/luminal management with balloon dilation, radial incision and self-bougination achieved 83% (15/18) symptom remission. Three patients received surgical intervention with esophagectomy or jejunostomy. Esophageal stricture is frequently encountered in esophageal ESD. Aggressive preventative strategy is warranted for the high-risk group. Endoscopy/luminal management has high efficacy for post-ESD esophageal stricture.

Full-time red dichromatic imaging during esophageal endoscopic submucosal dissection to address intraoperative bleeding.

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The relationship between the esophageal endoscopic submucosal dissection technical difficulty and its intraoperative process.

Estimating the esophageal endoscopic submucosal dissection (ESD) technical difficulty is important to reduce complications. Endoscopic duration is one of the related factors to a technical difficulty. The relationship between the esophageal ESD technical difficulty and its intraoperative process was analyzed as a first step toward automatic technical difficulty recognition using artificial intelligence. This study enrolled 75 patients with superficial esophageal cancer who underwent esophageal ESD. The technical difficulty score was established, which consisted of three factors, including total procedure duration, en bloc resection, and complications. Additionally, technical difficulty-related factors, which were perioperative factors that included the intraoperative process, were investigated. Eight (11%) patients were allocated to high difficulty, whereas 67 patients (89%) were allocated to low difficulty. The intraoperative process, which was shown as the extension of each endoscopic phase, was significantly related to a technical difficulty. The area under the curve (AUC) values were higher at all the phase duration than at the clinical characteristics. Submucosal dissection phase (AUC 0.902; 95% confidence intervals (CI) 0.752-1.000), marking phase (AUC 0.827; 95% CI 0.703-0.951), and early phase which was defined as the duration from the start of marking to the end of submucosal injection (AUC 0.847; 95% CI 0.701-0.992) were significantly related to technical difficulty. The intraoperative process, particularly early phase, was strongly associated with esophageal ESD technical difficulty. This study demonstrated the potential for automatic evaluation of esophageal ESD technical difficulty when combined with an AI-based automatic phase evaluation system.

Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis.

As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis. The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise. After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were > 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63cm2/h), and rate of conversion to EMR (from 22.0 to 8.1%). No significant differences could be observed for rates of R0 resection (65.9 vs. 69.6%), curative resection (55.8 vs. 55.7%), adverse events (16.3 vs. 11.7%), surgery due to adverse events (1.5 vs. 1.3%), and recurrence (12.5 vs. 4.5%). Subgroup and benchmark analysis revealed an improvement in esophageal, gastric, and rectal ESD with achievement of competence levels for the esophagus and stomach within 80 and most of the benchmarks for proficiency level within 120 procedures. Some of the benchmarks could also be achieved in rectal ESD. This trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer.

Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, multi-day (M-D) admission is required for patients undergoing ESD due to potential complications. To evaluate the feasibility of a same-day (S-D) discharge strategy for ESD of the esophagus or stomach. The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital. The propensity score matching (PSM) method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups. Intraoperative and postoperative parameters were compared between the matched groups. Among the 479 patients reviewed, 470 patients, including 91 in the S-D group and 379 in the M-D group, fulfilled the inclusion and exclusion criteria. Following PSM, 78 patients in each group were paired using the 1:1 nearest available score match algorithm. No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events (AEs). Tumor size, complete resection rate, and procedural duration were comparable between the groups. The S-D group demonstrated a significantly shorter length of hospital stay (P < 0.001) and lower overall medical expenses (P < 0.001) compared with the M-D group. The S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.

Variceal ligation in decompensated cirrhosis before esophageal endoscopic submucosal dissection

Video 1This video details our case as well as our method for successfully eradicating varices immediately prior to esophageal endoscopic submucosal dissection to minimize risks of variceal hemorrhage.

S1068 Safety and Feasibility of Same-Day Discharge After Endoscopic Submucosal Dissection: A Western Multicenter Prospective Cohort Study

Introduction: Patients undergoing endoscopic submucosal dissection (ESD) in Asia are traditionally admitted for routine post-procedural observation. Data on the feasibility of same-day discharge (SDD) following ESD remains scarce. We aimed to evaluate the safety and feasibility of SDD after ESD and to identify factors associated with admission. Methods: Retrospective post-hoc analysis of multicenter prospective cohort study of adults who underwent ESD at 10 participating centers from 2016 to 2021. The primary endpoint was safety and feasibility of SDD after ESD and to identify factors associated with admission. Endoscopists with < 50 cases were defined as low-volume ESD endoscopists. Lesions with Paris 0-IIc or III were considered to have a depressed morphology component. Results: 831 patients (57% male, median age 67 [IQR 57-74]) underwent esophageal (n=240), gastric (n=126), and colorectal (n=465) ESD, of which 588 (71%) underwent SDD and 243 (29%) were admitted. 13 (2%) in the SDD group had delayed bleeding, 9 requiring repeat endoscopy and 2 needing blood transfusion. Four patients (1%) had delayed perforation, of which only one required surgery. Out of the 243 admissions, 223 (92%) were discharged within 24 hours after routine post-procedural observation. Nineteen patients (8%) were admitted for the management of adverse events: 3 for bleeding and 16 for intraprocedural perforation. All these complications were managed endoscopically, and none required surgery. Mean hospital length of stay was 1.3±0.8 days. Interestingly, on multivariate analysis, lesion size ≥45 mm inversely correlated with admission (OR: 0.5; 95% CI: 0.3-0.8; P=0.001). All of the following factors were independently associated with a higher likelihood of admission: ESD in esophagus/stomach vs colorectal (OR: 1.7; 95% CI: 1.1-2.6; P=0.011), low endoscopist volume (OR: 2.1; 95% CI: 1.3-3.3; P=0.001), invasive cancer histology at baseline (OR: 1.9; 95% CI: 1.2-3.1; P=0.010), adverse events (OR: 2.7; 95% CI: 1.5-4.8; P=0.001), and procedure time >75 minutes (OR: 13.5; 95% CI 8.5-21.3; P< 0.001). (Table) Conclusion: SDD is feasible and safe, with less than 3% of patients developing delayed adverse events following SDD. Factors including ESD location, lesion size, baseline histology, endoscopist volume, and procedural time appear to correlate with need for admission. Additional studies are needed to identify predictors for SDD after ESD. Table 1. - Baseline characteristics of patients hospitalized and discharged following endoscopic submucosal dissection for esophageal lesions Baseline characteristic All (831) Admitted (243) Discharged (588) P-value Age (median, IQR) 67 (57 – 74) 68 (59 – 73) 66 (57 – 74) 0.185 Male sex 477 (57%) 138 (57%) 339 (58%) 0.823 ASA classIIIIIIIV 82 (10%)374 (45%)355 (43%)20 (2%) 12 (5%)103 (42%)112 (46%)16 (7%) 70 (12%)271 (46%)243 (41%)4 (1%) 0.005 Upper GI LocationEsophagusDistal esophagus/GEJEsophageal bodyStomachColorectal 240 (29%)161 (19%)79 (10%)126 (15%)465 (56%) 83 (35%)62 (26%)21 (9%)41 (17%)119 (49%) 157 (27%)99 (17%)58 (10%)85 (14%)346 (59%) 0.009 Endoscopist volume < 50 176 (21%) 80 (33%) 96 (16%) < 0.0001 Prior intervention at ESD site 197 (24%) 35 (14%) 162 (28%) < 0.0001 No fibrosisSubmucosal fibrosisMildModerateSevere 467 (56%)362 (44%)110 (13%)92 (11%)160 (19%) 158 (65%)85 (35%)14 (6%)16 (7%)55 (23%) 309 (53%)279 (47%)96 (16%)78 (13%)105 (18%) 0.0001 Lesion size, mm (median, IQR) 44 (32 – 60) 41 (30 – 60) 45 (33 – 59) < 0.0001 Depressed morphologyNon-depressed morphologyFlatElevatedMixedOther (i.e. submucosal) 111 (13%)720 (87%)375 (45%)208 (25%)90 (11%)47 (6%) 48 (20%)195 (80%)75 (31%)81 (33%)29 (12%)10 (4%) 63 (11%)525 (89%)300 (50%)127 (21%)61 (10%)37 (6%) 0.0004 Invasive cancerNon-invasiveIntramucosal cancerHigh grade dysplasiaLow grade dysplasiaSessile serrated adenomaHyperplastic polypNon-dysplastic lesionCarcinoid tumorOther 140 (17%)691 (83%)122 (15%)175 (21%)214 (26%)31 (4%)15 (2%)40 (5%)15 (2%)79 (10%) 63 (26%)180 (74%)40 (16%)39 (16%)46 (19%)16 (7%)5 (2%)9 (4%)3 (1%)22 (9%) 77 (13%)511 (87%)82 (14%)136 (23%)168 (29%)15 (3%)10 (2%)31 (5%)12 (2%)57 (10%) < 0.0001 Adverse eventsBleedingPerforationInfectionStrictureSedation-related 15 (2%)20 (2%)0 (0%)27 (3%)0 (0%) 3 (1%)16 (7%)0 (0%)13 (5%)0 (0%) 12 (2%)4 (1%)0 (0%)14 (2%)0 (0%) < 0.0001 Total procedure time, min (median, IQR) 76 (56 – 120) 136 (91 – 198) 69 (51 – 89) < 0.0001 En bloc resection rate 790 (94%) 219 (86%) 571 (96%) < 0.0001 R0 resection rate 713 (85%) 180 (73%) 533 (89%) < 0.0001 Curative resection rate 679 (81%) 172 (70%) 507 (85%) < 0.0001 IQR=Interquartile range. ASA=American Society of Anesthesiologists. GEJ=Gastroesophageal junction. HGD=High grade dysplasia. LGD=Low grade dysplasia.

Gel immersion endoscopic submucosal dissection: clinical experience with 13 cases of superficial esophageal cancer.

Esophageal endoscopic submucosal dissection (ESD) of tumors located on the gravity side is technically challenging. Given that gel immersion ESD (GIESD) is performed by immersing lesions in gel, we hypothesized that it could be used to eliminate the disadvantage associated with submerging the gravity side. Here, we performed GIESD using VISCOCLEAR for superficial esophageal cancer on the gravity side of the esophagus, with monopolar devices. This study aimed to evaluate the short-term outcomes of GIESD for superficial esophageal cancer. Fifteen patients with 16 superficial esophageal cancers underwent GIESD by a single operator, and 13 cases were evaluated. All patients were male, and GIESD was performed in the middle (12/13, 92.3 %) and lower (1/13, 7.7 %) thoracic esophagus. The lesions were located on the left (7/13, 53.8 %), posterior (5/13, 38.5 %), and right (1/13, 7.7 %) esophageal walls. The median procedure time was 27 minutes (interquartile range [IQR], 14–68), and the median dissection speed was 20 mm 2 /min (IQR, 14–25.7). The median amount of gel used was 400 mL (IQR, 360–580), and no gel-related adverse events were observed. The median total dose of midazolam was 3 mg (IQR, 2–5). GIESD was completed with en bloc and R0 resections achieved in 100 % of the 13 cases. Delayed adverse events, such as bleeding or perforation, did not occur (0/13, 0 %).

Efficacy of a gel injected using an endoscopic water jet for visualization of active bleeding during esophageal endoscopic submucosal dissection.

Efficacy of a gel injected using an endoscopic water jet for visualization of active bleeding during esophageal endoscopic submucosal dissection.

Outcome of a novel self-control stricture-preventing water balloon for complete circular esophageal endoscopic submucosal dissection.

Post-ESDesophagealstricture especially after wholly circumferential ESD remains an unresolved issue without ideal strategies. Our initiative novel self-control stricture-preventing water balloon may be an alternative. Patients with esophageal neoplastic lesions expected to result in a whole circular mucosa defect after esophageal ESD from February 2018 to August 2020 were included in the study. We used a novel self-control stricture-preventing water balloon combined with oral prednisolone as preventive strategy for the enrolled patients. Thirty-seven patients (9 females and 28 males, patients aged 52 to 82years) finished the 12-week treatment including steroid treatment and balloon placement. The median size of longitudinal diameter was 7cm (range from 4 to 14cm). All the lesions achieved curative resection and the median procedure time was 110min (range 50 to 180min). Balloons were found migration in 4 patients. As a result, there were 3 patients (8.1%) experienced stricture. Generally, patients could tolerate to balloons, only with mild uncomfortableness, such as occasional sore throat, cough, and retrosternal pain. In addition, during the follow-up period, no significant adverse events associated to oral steroid administration were observed and no recurrence was found. Our novel self-control stricture-preventing water balloon based on the oral steroid therapy is effective and safe. This strategy well prevents esophageal stricture after complete circumferential ESD.

Tunneling and clip-with-line techniques for successful long circumferential esophageal endoscopic submucosal dissection.

Tunneling and clip-with-line techniques for successful long circumferential esophageal endoscopic submucosal dissection.

Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer.

Background/AimsIntralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety. MethodsIntralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. ResultsAlthough stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed. ConclusionsIntralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis (clinical trial number, UMIN000037567).

Propensity-score matched analysis to evaluate efficacy of endoscopic submucosal dissection for superficial esophageal cancer in gastrectomized patients

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment option for superficial esophageal cancer (SEC) with high rates of complete resection. However, limited research exists on the efficacy of ESD for SEC in gastrectomized patients. This study aimed to evaluate the efficacy of ESD for SEC in gastrectomized patients. We included 318 patients of SEC treated at our institution between April 2005 and October 2021. To minimize bias between the gastrectomized and non-gastrectomized groups, we conducted a propensity-score matched analysis and compared the ESD outcomes for SEC of the two groups. Of the 318 patients included in the study, 48 and 270 patients were in the gastrectomized and non-gastrectomized groups, respectively. After 1:2 propensity-score matching, we matched 44 patients in the gastrectomized group to 88 patients in the non-gastrectomized group, and found no significant differences in the baseline clinicopathological characteristics. Regarding the ESD outcomes, there were no significant differences in the complete resection rate, procedure time, hospitalized period, and recurrence rates between the two groups. Multivariate analysis also cofirmed that the history of gastrectomy was not a risk factor of the difficult case of esophageal ESD. In conclusion, history of gastrectomy might not negatively affect the ESD outcomes of SECs.