Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma

Yamashita, Tatsuya; Zeniya, Akira; Ishii, Hajime; Tsuji, Takeshi; Tsuda, Satoko; Nakane, Kunio; Komatsu, Masafumi

doi:10.1007/s00464-011-1584-6

Cited by 40 publications

(28 citation statements)

References 21 publications

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“…In addition, although two patients with m2 or sm1 cancer died of other causes, the cause-specific survival rate at 5 years was 100% for patients with SESCC. This survival rate is consistent with the findings of previous studies on ESD in SESCCs 8,21,22. Because of the higher comorbidity of esophagectomy and the higher incidence of incomplete resection by EMR,9,23 ESD may be a superior treatment option for SESCCs, regardless of their size or submucosal fibrosis.…”

Section: Discussionsupporting

confidence: 90%

“…However, our results indicate that the complications accompanying ESD occurred with the same frequency as in previous studies 8,21. In the present study, esophageal perforation, which is potentially life threatening and may induce severe mediastinitis, occurred in two patients (7%).…”

Section: Discussionsupporting

confidence: 77%

“…Although small lesions can be treated by EMR with a single or very few resections, piecemeal resection of large lesions is insufficient for histological assessment of SESCCs. Furthermore, unnecessary nonneoplastic mucosal resection, which is avoidable by ESD, may cause severe postoperative stenosis 8. Considering the risks and benefits, ESD is recommended for m1 or m2 SESCCs >2 cm, and m3 or deeper squamous cell carcinomas of any size, to obtain en bloc resection with sufficient tumor-free margins and to completely remove invasive lesions 14…”

Section: Discussionmentioning

confidence: 99%

“…However, conventional EMR techniques present limitations in terms of resectable lesion size, and large lesions should be resected in a piecemeal manner 7,8. Furthermore, EMR caused intense thermal denaturation of the lesion, which makes it difficult to perform precise histopathologic evaluation of the piecemeal-resected specimen, needed to determine the risk of lymph node metastasis 9.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study

Joo¹,

Kim²,

Park³

et al. 2014

Gut Liver

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Background/AimsSuperficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs.MethodsBetween January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated.ResultsThe en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively.ConclusionsESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study

Joo¹,

Kim²,

Park³

et al. 2014

Gut Liver

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“…However, the results of these studies were rather controversial with the R0 resection rate ranging from 71% to 97% [6,7]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis

Sun

Yuan

Chen

et al. 2014

J Cardiothorac Surg

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AimFor patients with superficial esophageal carcinoma, ESD was one of treatment modalities to remove the lesion safely and effectively. We perform this meta-analysis to determine the efficacy and incidence of complication of ESD for patients with superficial esophageal carcinoma.MethodArticles were searched in MEDLINE (PubMed and Ovid), Cochrane Database of Systemic Reviews, Google scholar, and Web of Science. Two reviewers independently searched and extracted data. Meta-analysis of the efficacy of ESD was analyzed by calculating pooled en bloc and R0 resection rate. Incidence of complications such as perforation, stenosis and mediastinal emphysema was also calculated. Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies.Results21 studies (1152 patients and 1240 lesions) were included in this analysis. The pooled en bloc resection rate was 99% (95% CI 99%-100%). Stratified by tumor size, en bloc resection rates did not show any significant difference. The pooled R0 resection rate was 90% (95% CI 87%-93%). The pooled R0 resection rate was 85% (95% CI, 80%-90%) for large tumor and 92% (95% CI, 87%-93%) for small tumor (p < 0.001). Stenosis served as the most common reported complication with pooled incidence of 5% (95% CI 3-8%), followed by perforation (1%, 95% CI 0-1%) and mediastinal emphysema (0% CI 0-1%). The incidence of postoperative stenosis decreased significantly after 2011 (2%, 95% CI 0-3%) compared with that before 2011 (9%, 95% CI 3-8%) (p < 0.001).ConclusionESD was an efficient modality for treating superficial esophageal carcinoma, with perfect en bloc and R0 resection rate and low complication rate. The most common complication of ESD was stenosis. Although recurrence rate was low, patients should be maintained in a scheduled surveillance program.

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Endoscopic resection of esophageal squamous cell carcinoma: Current indications and treatment outcomes

et al. 2021

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Endoscopic resection (ER) is an alternate minimally invasive treatment for superficial esophageal squamous cell carcinoma (SESCC). We aimed to review the clinical indications and treatment outcomes of ER for SESCC. Endoscopic mucosal resection is relatively easy and efficient for SESCC ≤ 15 mm. In contrast, endoscopic submucosal dissection (ESD) is recommended to achieve en bloc resection for lesions >15 mm, in view of the accurate pathological evaluation. The Japan Gastroenterological Endoscopy Society guidelines recommend ER for non‐circumferential cT1a‐EP/LPM (epithelium/lamina propria mucosae), cT1a‐MM/T1b‐SM1 (muscularis mucosa/superficial submucosa ≤ 200μm) SESCC, and whole‐circumferential T1a‐EP/LPM SESCC ≤ 50 mm (upon implementing preventive measures for stenosis), considering the risk‐benefit balance of ER. It defines pT1a‐EP/LPM without lymphovascular invasion as a curative endoscopic resection. The guidelines recommend additional esophagectomy or chemoradiotherapy for pT1b SESCC or any SESCC, with lymphovascular invasion. However, there is no recommendation for or against the administration of additional treatments for pT1a‐MM without lymphovascular invasion, owing to limited evidence. Researchers have reported on high en bloc and R0 resection rates of ESD, and a randomized controlled trial demonstrated that clip‐line traction‐assisted ESD could significantly reduce the ESD procedural time. Moreover, steroid treatment has been developed to prevent post‐ESD esophageal strictures. There have been reports on favorable long‐term outcomes of ESD. However, most of them are retrospective studies. Further robust data in prospective trials are warranted to achieve a definitive evidence of ESD, which will be beneficial to patients with SESCC.

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Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma

Cited by 40 publications

References 21 publications

Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study

Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study

Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis

Endoscopic resection of esophageal squamous cell carcinoma: Current indications and treatment outcomes

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