Superficial Esophageal Squamous Cell Neoplasms Research Articles

Endoscopic submucosal tunnel dissection with an elastic traction device for a circumferential superficial esophageal neoplasm.

Endoscopic submucosal dissection (ESD) is an established treatment for superficial esophageal squamous cell neoplasms (SESCNs) [1] [2]. However, it is time-consuming and challenging for large SESCNs, especially circumferential lesions. Endoscopic submucosal tunnel dissection (ESTD) has been reported as an effective technique for circumferential SESCNs [3] [4]. Herein, we report a case of traction-assisted ESTD using a novel elastic traction device (Micro-Tech, Nanjing, China), consisting of a rotatable soft-tissue clip and an elastic double ring attached to the clip arm ([Fig. 1]).

The Feasibility and Safety of Endoscopic Submucosal Dissection for Circumferential Superficial Esophageal Squamous Cell Neoplasms.

Background It remains controversial whether endoscopic submucosal dissection (ESD) is still appropriate for circumferential superficial esophageal squamous cell neoplasms (SESCN), and few studies compared the short-term and long-term outcomes of ESD with radical surgery. Methods A total of 140 patients with SESCN who underwent ESD or surgery between February 2014 and October 2021 were retrospectively reviewed. The characteristics of patients, operative time, postoperative complications, overall survival (OS), recurrence-free survival (RFS), and quality of life (QOL) were compared between the ESD and surgery groups. The effect of different methods to prevent esophageal stenosis after ESD were analysed. Results Drinking, family history of cancer, macroscopic type, and intrapapillary capillary loop (IPCL) type were independent risk factors for deep submucosal invasion (SM ≥ 200 μm). Smoking and IPCL type were independent predictive factors for angiolymphatic invasion. The average operative time of ESD was significantly shorter than that of surgery (174.5 ± 51.16 min vs. 255.9 ± 88.18 min, p < 0.001). The incidence of perioperative complications in ESD group was significantly lower than that in surgery group (5.5% vs. 19.4%, p = 0.015). The ESD group had significantly better functional scale scores for emotional functioning, cognitive functioning, and global health status, and lower rates of pain, dyspnoea, insomnia, appetite loss, diarrhoea, reflux, and trouble with taste than the surgery group. No significant difference in OS and RFS between ESD and surgery group. Conclusions ESD can significantly shorten the operative time and reduce perioperative complications. Additionally, on the premise of using appropriate measures to prevent postoperative stenosis, ESD can be the first choice for the treatment of SESCN, which could provide better QOL, and the long-term prognosis of ESD is no less than that of surgery.

Novel genomic alteration in superficial esophageal squamous cell neoplasms in non-smoker non-drinker females

Alcohol consumption and smoking pose a significant risk for esophageal squamous cell neoplasia (ESCN) development in males; however, ESCN is often diagnosed in non-drinking and non-smoking females. The mechanisms underlying these differences remain elusive, and understanding them can potentially identify novel pathways involved in ESCN development. We performed short-read sequencing to identify somatic variants on a cancer panel targeting 409 genes using DNA extracted from the superficial squamous cell carcinoma (ESCC) tissues and adjacent non-neoplastic epithelium (NE), and immunohistochemical staining of the protein encoded by the target gene. All male patients (n = 117) were drinkers or smokers, whereas 45% of the female patients (n = 33) were not. Somatic variants were compared among three age-matched groups: 13 female ESCC patients with smoking and drinking habits (known-risk group, F-KR), 13 female ESCC patients without these habits (unknown-risk group, F-UR), and 27 males with ESCC and smoking and drinking habits (M-KR). In the NE, the frequencies of CDKN2A variants were significantly higher in F-UR than in F-KR and M-KR. In both ESCC and NE, p14ARF was significantly overexpressed in F-UR than in the other groups. In conclusion, CDKN2A might be important in ESCC development, independent of known risk factors.

Autologous skin-grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dissection: a case-matched controlled study.

The incidence of postoperative stenosis after endoscopic resection of wholly circumferential superficial esophageal squamous cell neoplasms (SESCNs) is extremely high. Between January 2011 and April 2019, 19 patients who underwent autologous skin-grafting surgery (ASGS) after complete circular endoscopic submucosal tunnel dissection (ccESTD) were enrolled to form the ASGS group. Cases in the ASGS group were individually matched at a 1:1 ratio to cases undergoing fully covered esophageal stent (FCES) placement alone (FCES group) based on pathological diagnosis, curative resection, longitudinal length of ulceration, lack of stent migration, time to stent removal, follow-up period and operators. Baseline characteristics and treatment outcomes were compared between the two groups. Baseline characteristics were comparable between the ASGS group and the FCES group. The incidence of patients with esophageal stenosis after removal of the stent in the ASGS group was significantly reduced compared that in the FCES group (36.8% vs 78.9%, p = 0.020). Comparison of preventive methods (ASGS vs FCES alone) between the stenosis group and nonstenosis group revealed that ASGS accounted for a higher proportion than FCES alone in the nonstenosis group (p = 0.020). Compared with FCES placement alone, ASGS appeared to be more effective in preventing esophageal stenosis after ccESTD for SESCNs.

Clinical outcomes of endoscopic submucosal tunnel dissection compared with conventional endoscopic submucosal dissection for superficial esophageal cancer: a systematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal cancer. However, it has limitations in case of large superficial esophageal squamous cell neoplasms (SESCNs), in which submucosal injection cannot attain satisfactory lifting effects. Thus, endoscopic submucosal tunnel dissection (ESTD) was introduced as a new treatment for SESCNs presenting satisfying results. Many studies have tried to verify the efficacy of ESTD, yet no meta-analysis has been published until now. We searched the databases of PubMed, Cochrane Library, Web of Science, SinoMed, Wanfang, and CNKI dating up to February 1, 2019. Studies comparing the clinical outcomes of ESTD and ESD for superficial esophageal cancers were enrolled. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of these studies. Eight articles were included that involved a total of 625 superficial esophageal cancer patients. Our analysis revealed that ESTD is superior to ESD as it has higher en bloc resection rate, shorter operation time, and lower recurrence rate 1 year after operation. The R0 resection rate and postoperative adverse event rate of ESTD group is comparable with ESD group. Our study implicates that ESTD is a potentially superior treatment to ESD for superficial esophageal cancer.

Predictors of Postoperative Stricture After Endoscopic Submucosal Dissection for Large Superficial Esophageal Squamous Cell Neoplasms

Introduction: Endoscopic submucosal dissection (ESD) has been widely accepted for resecting superficial esophageal squamous cell neoplasms (ESCNs). The aim of this study was to evaluate the predictors for postoperative stricture after ESD for large ESCNs (>3/4 circumferential mucosal defect). Methods: We consecutively enrolled 63 patients with large ESCNs(Histologic depth<sm1) who underwent ESD at the Chinese PLA General Hospital were enrolled. Patients were grouped as post-ESD stricture group and no post-ESD stricture group according to stricture occurrence or not after ESD. The demographic characteristics of the patients and the tumor and technical factors were analyzed for investigating predictive factors of postoperative stricture. Results: All the ESD procedures were successfully performed for 63 patients of which 25(39.4%) taking prophylactic methods for preventing post-ESD stricture. The rates of postoperative stricture for different circumferential defects of ≥3/4 to <7/8, ≥7/8 to <4/4 and 4/4 were 38.2%(13/34), 50.0%(6/12) and 76.5%(13/17) respectively. The total stricture rate was 50.8%(32/63). Patients with post-ESD stricture had a significantly higher degree of circumferential mucosal defect(P=0.036), larger longitudinal tumor size ((5.72±2.16) versus (4.24±1.61) cm, P = 0.003) and more patients with presence of muscle injury(9 vs 2, P = 0.023).There was no significant differences in age, sex, tumor location, macroscopic type, procedure time, the longitudinal diameter of specimens, the circumferential diameter of specimens, en bloc resection, histological depth and taking prophylactic measures (P>0.05). After multivariate analysis, circumferential mucosal defect (≥ 7/8) and not taking prophylactic measures are predictors for stricture development in patients with large ESCNs after ESD. Conclusion: Circumferential mucosa defect >7/8 is the main factor leading to the stricture of the esophagus after ESD for large early ESCNs. For patients with post- operative circumferential mucosa defect >3/4, appropriate preventive measures can effectively reduce the incidence of postoperative stricture after ESD.354_A Figure 1. Groups according to circumferential mucosal defect. Patients who underwent ESD or ESTD for large superficial esophageal squamous cell carcinoma(ESCC):Group A, ≥3/4 and <7/8; Group B, ≥7/8 and <4/4; Group C, entire circumferential mucosal defect(4/4)354_B Figure 2. Stricture was encountered after submucosal dissection (ESD) involving total circumferential resection. A. Chromoendoscopy with iodine staining revealed a discolored area in the lower esophagus. B. Entire (4/4) circumferential mucosal defect after ESD. C. Resected sleeved specimen with the lesion in an en bloc resection, the length of which was approximately 4.5 cm. D. A fully covered esophageal stent was implanted for prevention of stricture. E. Endoscopy displayed stricture 63 days after ESD. F. Endoscopic balloon dilatation is performed against the postoperative stricture. G. The stricture site was dilated after balloon dilatation, a 9.8-mm-diameter esophagogastroduodenoscopy (EGD) could be passed through this lumen. H. The lumen 7 months after ten EBD treatments.354_C Figure 3. The detailed data of the 63 patients enrolled in the study.

Single- and double-tunnel endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms.

Single-tunnel endoscopic submucosal tunnel dissection (ESTD) has shown promising preliminary efficacy for large superficial esophageal squamous cell neoplasms (SESCNs). This study reports the outcomes of both single- and double-tunnel ESTD for large SESCNs, and compares the efficiency of the two techniques for treating circumferential SESCNs. 46 patients with large SESCNs underwent ESTD at a single hospital between October 2011 and March 2016. Relevant clinical data were retrospectively collected and analyzed. For all patients, the en bloc and R0 resection rates were 95.7 % and 82.6 %, respectively. Perforation and cardiac mucosal laceration were detected in 2.2 % (1/46) and 6.5% (3/46) of the procedures, respectively. Postoperative stenosis occurred in 12 patients (26.1 %). Of the 18 patients with circumferential lesions, those who received a double-tunnel ESTD procedure (n = 6) underwent dissection faster than those who had a single-tunnel ESTD procedure (n = 12) (0.32 vs. 0.12 cm2/min; P = 0.02). ESTD was effective for large SESCNs. The double-tunnel ESTD appeared to decrease operative time compared with single-tunnel ESTD for circumferential lesions.

Esophageal endoscopic submucosal dissection using sodium hyaluronate is safe and effective

Background/Aims: A submucosal cushion of sodium hyaluronate facilitates gastric and colorectal endoscopic submucosal dissection (ESD). However, few studies have evaluated the utility of sodium hyaluronate for ESD of esophageal lesions. The aim of this study is to evaluate the utility and safety of sodium hyaluronate for ESD of superficial esophageal squamous cell neoplasms (ESCN).Material and methods: We retrospectively reviewed 111 ESCN in 86 patients treated by ESD between September 2007 and April 2013. There were four double cancers, with 107 ESD procedures analyzed.Results: The en bloc resection rate was 99% (106/107). The R0 resection rate was 93% (99/107). Of 106 specimens resected en bloc, four specimens had a positive horizontal margin, two specimens had non-assessable horizontal margins and one specimen had non-assessable horizontal and vertical margins. One patient with a non-assessable horizontal margin developed local recurrence seven months later, treated by repeat ESD. Delayed bleeding occurred in two procedures (2%), and intra-procedural perforation occurred in four (4%). None required operative repair. Endoscopy trainees performed 33 of 107 (31%) ESD procedures. Post-ESD stenosis requiring dilation occurred following five procedures (5%).Conclusions: Sodium hyaluronate for ESD of ESCN achieves a high R0 resection rate with a low rate of adverse events.

Advanced Oropharyngeal Cancer Can Be Easily Missed During Esophagogastroduodenoscopy.

The case of an elderly man with an advanced oropharyngeal cancer that was missed during esophagogastroduodenoscopy is described. He was referred for endoscopic resection of superficial esophageal squamous cell neoplasms. He died a month after referral due to an advanced oropharyngeal cancer with a metastatic lesion to the brain. Patients with esophageal squamous cell carcinoma are high risk for head and neck cancer. The pharynx is the most common site for cancer in the head and neck region. Consequently, the pharynx should be observed carefully when patients with esophageal squamous cell carcinoma undergo esophagogastroduodenoscopy.LEARNING POINTSHead and neck cancer develops in approximately 10% of patients with esophageal squamous cell carcinoma.The pharynx should be observed carefully when patients with esophageal squamous cell carcinoma undergo esophagogastroduodenoscopy because the pharynx is the most common site for cancer in the head and neck region.Sedation using narcotic drugs can reduce the gag reflex but still allow patients to vocalize and offer adequate conditions for pharyngeal observation during esophagogastroduodenoscopy.

Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms.

Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD.

Su1819 Evaluation of the Expanded Indication of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Neoplasms

[Background and Aim] Since the technical advance and the development of new devices, endoscopic submucosal dissection (ESD) is widely utilized for the treatment of superficial esophageal squamous cell neoplasms (ESCNs). In the treatment of ESCNs without nodal metastasis, ESD achieves the similar clinical outcomes to those of esophagectomy and chemoradioherapy and is much less invasive than them. The intensive studies of histopathological analysis of surgically resected ESCNs have proven that the cases of non-invasive carcinoma (EP, carcinoma in situ) and intra-mucosal invasive carcinoma limited to the lamina propria mucosae (LPM) had an extremely low risks of lymph node and distant metastasis. Based on these findings, the Japanese guideline for the treatment of esophageal cancer states that both EP and LPM cases are suitable for ESD. On the other hand, the lymph node metastasis rate of ESCNs invading to the muscularis mucosae (MM) including both with and without lymphovascular invasion has been reported as 7-10 %. Thus, ESD treatment had not been positively recommended for MM cases. However, it is assumed that MM cases without lymphovascular invasion have no lymph node metastasis. Thus, there exists the possibility that MM cases without lymphovascular invasion can be suitable for ESD. In this study, therefore, we evaluated expanded ESD indication to the MM cases without lymphovascular invasion, by analyzing surgically resected specimens histopathologically and investigating the clinical outcomes both after surgery and ESD of MM cases without lymphovascular invasion. [Methods] MM cases without lymphovascular invasion surgically treated between January 2001 and December 2010 (11 cases) and those treated with ESD between January 2006 and August 2012 (30 cases) at Akita University Hospital were enrolled in this study. [Results] In the detailed histopathological analysis of the surgically resected specimens of 11 MM cases without lymphovascular invasion, no lymph node metastasis was detected. No recurrence or metastasis developed in any of these 11 cases until today. In the analysis of the ESD-treated, 30 MM cases were proven to have no lymphovascular invasion by the histopathological examination of the specimens endoscopically resectd en bloc. Then, no additional therapy such as chemoradiotherapy was performed for these cases. However, all of the 30 cases are still alive without recurrence or metastasis during the followup period (4-81 months, average 33.8 months). [Conclusion] Our current study elucidated that MM cases without lymphovascular invasion has no risk of lymph node metastasis, and clinical outcomes of the ESD-treated MM cases without lymphovascular invasion are extremely satisfactory. These data suggest that ESD indication for superficial ESCNs treatment can be expanded to the MM cases without lymphovascular invasion.

Su1820 The Distribution of Gastric Diseases Based Upon National Cancer Endoscopic Screening Program in Korea for 7 Years

[Background and Aim] Since the technical advance and the development of new devices, endoscopic submucosal dissection (ESD) is widely utilized for the treatment of superficial esophageal squamous cell neoplasms (ESCNs). In the treatment of ESCNs without nodal metastasis, ESD achieves the similar clinical outcomes to those of esophagectomy and chemoradioherapy and is much less invasive than them. The intensive studies of histopathological analysis of surgically resected ESCNs have proven that the cases of non-invasive carcinoma (EP, carcinoma in situ) and intra-mucosal invasive carcinoma limited to the lamina propria mucosae (LPM) had an extremely low risks of lymph node and distant metastasis. Based on these findings, the Japanese guideline for the treatment of esophageal cancer states that both EP and LPM cases are suitable for ESD. On the other hand, the lymph node metastasis rate of ESCNs invading to the muscularis mucosae (MM) including both with and without lymphovascular invasion has been reported as 7-10 %. Thus, ESD treatment had not been positively recommended for MM cases. However, it is assumed that MM cases without lymphovascular invasion have no lymph node metastasis. Thus, there exists the possibility that MM cases without lymphovascular invasion can be suitable for ESD. In this study, therefore, we evaluated expanded ESD indication to the MM cases without lymphovascular invasion, by analyzing surgically resected specimens histopathologically and investigating the clinical outcomes both after surgery and ESD of MM cases without lymphovascular invasion. [Methods] MM cases without lymphovascular invasion surgically treated between January 2001 and December 2010 (11 cases) and those treated with ESD between January 2006 and August 2012 (30 cases) at Akita University Hospital were enrolled in this study. [Results] In the detailed histopathological analysis of the surgically resected specimens of 11 MM cases without lymphovascular invasion, no lymph node metastasis was detected. No recurrence or metastasis developed in any of these 11 cases until today. In the analysis of the ESD-treated, 30 MM cases were proven to have no lymphovascular invasion by the histopathological examination of the specimens endoscopically resectd en bloc. Then, no additional therapy such as chemoradiotherapy was performed for these cases. However, all of the 30 cases are still alive without recurrence or metastasis during the followup period (4-81 months, average 33.8 months). [Conclusion] Our current study elucidated that MM cases without lymphovascular invasion has no risk of lymph node metastasis, and clinical outcomes of the ESD-treated MM cases without lymphovascular invasion are extremely satisfactory. These data suggest that ESD indication for superficial ESCNs treatment can be expanded to the MM cases without lymphovascular invasion.

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Endoscopic resection is an effective treatment for non-invasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation. Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms

Background and Aim: There has been a marked increase in the number of esophageal squamous cell neoplasms (SCNs) which are applicable to local treatment by virtue of recent developments in endoscopy. Endoscopic submucosal dissection (ESD) is an effective treatment for early noninvasive gastrointestinal cancers.&#x0D; Aim of this study was to evaluate efficacy of ESD for superficial esophageal squamous cell neoplasms.&#x0D; Subjects &amp; Methods: Between November 2010 and March 2012, seventy-two lesions with superficial esophageal squamous cell neoplasms, which were treated by ESD in Kumamoto University Hospital, were analyzed in this study. Therapeutic efficacy, complications, and follow-up results were assessed.&#x0D; Results: Mean size of the lesions was 19±14 mm (range; 1-80 mm); and mean size of the resection specimens was 29±13 mm (range; 7- 80mm). Extensive lesions over 2/3 of the circumference were observed in 17 patients. En bloc resection rate was 100% (72/72), and en block resection rate with tumor-free lateral/basal margins was 95.8% (69/72). Perforation didn’t occur. Endoscopic dilation was performed for post-operative stenosis in 10 patients. In 3 patients who developed pinhole-like stenosis followed by circumferential ESD, combination treatment of oral steroid administration with endoscopic dilation could achieve favorable courses. None of the patients developed local recurrence or distant metastasis in the follow-up period.&#x0D; Conclusion: ESD is a minimally invasive, relatively safe treatment method for esophageal SCNs. In particular, it is suggested that ESD combined with oral steroid administration and endoscopic dilation, might be applicable to the patients with circumferential SCNs where post-operative stenosis must follow circumferential ESD.

S1512: The Present Situation of Esophageal ESD in Our Hospital

The detection of superficial esophageal squamous cell neoplasms has increased thanks to advances in electronic endoscopy. Endoscopic submucosal dissection (ESD) is accepted as a treatment method for superficial esophageal squamous cell neoplasms.

Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms

To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The en block resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Retrospective study from a single institution. From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. The rates of en bloc resection and complete resection were 100% and 88%, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively. This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.

Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms

Although endoscopic submucosal dissection (ESD) is becoming accepted as an established treatment for superficial esophageal squamous cell neoplasms, the risks for developing postoperative stricture have not been elucidated. This was a retrospective study at a single institution. From January 2002 to October 2008, 65 patients with high-grade intraepithelial neoplasms (HGINs) or m2 carcinomas treated by ESD were enrolled. Predictors of postoperative stricture were investigated by comparing results from 11 patients who developed strictures with those from 54 patients who did not. Significant differences between the two groups were observed in longitudinal diameter (45.0 +/- 15.9 mm vs. 31.5 +/- 13.6 mm) and circumferential diameter (37.2 +/- 8.6 mm vs. 26.8 +/- 9.7 mm) of the resected specimens, and the proportion of extension to the whole circumference of the lumen (< 1 / 2/ > 1 / 2/ > 3 / 4 : 2 / 4 / 5 vs. 40 / 13 / 1), histologic depth (HGIN/m2 : 2 / 9 vs. 41 / 13), and procedure time (85.6 +/- 42.8 minutes vs. 53.3 +/- 30.1 minutes). Multivariate analysis revealed that circumferential extension of > 3 / 4 (odds ration [OR]: 44.2; 95 % confidence interval [CI]: 4.4 - 443.6) and histologic depth to m2 (OR: 14.2; 95 %CI: 2.7 - 74.2) are reliable risk factors. Subanalysis for each category by combinations of these risk factors revealed that patients with lesions in > 3 / 4 of the circumferential area were associated with a high rate of postoperative stricture. By contrast, patients with HGIN lesions in < 3 / 4 extension have no probability of postoperative strictures. Additionally, subanalysis of patients with m2 lesions in < 3 / 4 circumferential extension revealed that circumferential diameter can be a reliable predictor for postoperative stricture. Circumferential extension and histologic depth are the reliable risk factors for postoperative strictures. In combination with circumferential diameter, we can perform effective and appropriate preventive balloon dilatations after esophageal ESD.

Long-Term Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Neoplasms

Long-Term Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Neoplasms