Endoscopic Submucosal Dissection for Adenocarcinomas of the Esophagogastric Junction

Abstract

Background: Adenocarcinoma of the esophagogastric junction (EGJ) is uncommon in Eastern countries, including Japan, but it is believed that the incidence of EGJ adenocarcinoma will increase in Asia in the future due to the decreasing incidence of Helicobacter pylori infection. Endoscopic submucosal dissection (ESD) is a minimally invasive and curative treatment that allows precise pathological assessment. Summary: Magnifying endoscopy with narrow-band imaging may be useful for differential diagnoses and for delineating the cancer margin of EGJ adenocarcinoma, but subsquamous carcinoma extension, which is the invasion of EGJ adenocarcinoma beneath the normal esophageal squamous epithelium, makes it difficult to detect cancer margins of the oral side in ESD for EGJ adenocarcinoma. Since subsquamous carcinoma extension was reported to be less than 1 cm in most cases, the oral safety margin that is placed 1 cm from the squamocolumnar junction is useful for negative cancerous horizontal margin. A multicenter retrospective study of esophageal adenocarcinoma including EGJ adenocarcinoma showed that mucosal and submucosal cancer within 500 μm from the muscularis mucosa without lymphovascular involvement, a poorly differentiated component, and lesion size over 3 cm were not associated with metastasis. Several retrospective studies about ESD for EGJ adenocarcinoma have suggested feasible short-term and long-term outcomes using curative criteria based on gastric cancer guidelines. Key Messages: ESD would be a good first-line treatment for superficial EGJ adenocarcinoma, including Barrett’s adenocarcinoma. Additional information about the incidence of metastasis would help confirm the indication of ESD for EGJ adenocarcinoma.

Predictive Factors of Postendoscopic Submucosal Dissection Electrocoagulation Syndrome and the Utility of Computed Tomography Scan after Esophageal Endoscopic Submucosal Dissection

“…Endoscopic submucosal dissection (ESD) emerged as an endoscopic treatment for gastrointestinal tumors in the 1990s and is now widely used as a beneficial curative therapy owing to its minimal invasiveness and good postoperative outcomes in activities of daily living. The use of ESD for superficial esophageal carcinoma is particularly advantageous in terms of postoperative activities of daily living compared with surgery [1][2][3]; however, a number of procedural accidents, including perforations, can occur during ESD [4][5][6]. The esophagus is anatomically characterized by the absence of a serosa, which means that mediastinal emphysema can occur with ESD, even without perforation [7,8].…”

Overview of gastroesophageal junction cancers

“…ESD has been accepted as the minimally invasive curative treatment option for superficial early gastrointestinal cancers including those of stomach, esophagus and colonic origins [24] . However, the indication of endoscopic treatment for early GEJ cancers including Barret's adenocarcinoma has not been clearly established due to unclear pattern of lymph node metastasis [25] . Meta-analysis of 6 retrospective studies have demonstrated the safety and feasibility of ESD on early superficial GEJ cancers [26] .…”

Detection of early adenocarcinoma of the esophagogastric junction by spraying an enzyme-activatable fluorescent probe targeting Dipeptidyl peptidase-IV

“…Even in Asia, including Japan, there is concern that the incidence of esophagogastric junctional adenocarcinoma will increase following a decrease in the H. pylori infection rate [2,3]. Early stage adenocarcinoma of the EGJ can be endoscopically resected, such as by endoscopic submucosal dissection (ESD), and is expected to achieve good oncological outcomes [4][5][6]. On the other hand, the prognosis of advanced esophageal adenocarcinoma, including esophagogastric adenocarcinoma and Barrett's adenocarcinoma, is poor, and its early detection is necessary for better prognosis [7][8][9].…”