Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

Abstract

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.

Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions

“…For this reason, it is especially appropriate for large mucosal lesions[ 11 ]. Zhai et al[ 19 ] obtained similar findings and noted that ESTD is indicated when (1) lesions do not invade deeper than sm1 and have no evidence of lymph node metastasis and (2) the lesion’s circumference level ≥ 1/3 or the diameter ≥ 2 cm.…”

Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis

“…Postoperative ES is of most concern for large mucosal defects after ESTD because of reduced quality of life. The size of the lesion and histological depth may be reliable predictors of postoperative stricture [10]. In order to reduce the incidence of postoperative stricture, some scholars have reported different methods for the treatment and prevention of ES after ESD or ESTD, such as oral and local injection/administration of steroids, postoperative placement of retrievable metal stents in the esophagus, transplantation of the oral mucosal epithelium, and injection of mesenchymal stem cells [31].…”

“…Inspired by the reported success of the submucosal tunnel endoscopic method, endoscopic submucosal tunnel dissection (ESTD) was developed as an alternative technique for the treatment of esophageal neoplastic lesions, especially circumferential superficial esophageal neoplastic lesions (SENLs) [10]. A number of singlecenter studies have reported promising outcomes with the clinical application of ESTD [11,12].…”

Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection

“…ESTD is indicted for lesions >20 mm in diameter and involving at least one third of the esophageal circumference. 20 A propensity matching analysis by Huang et al 18 demonstrated ESTD significantly shortened the ESD procedural time (38.0 minutes vs 48.0 minutes, p=0.006) and the submucosal dissection time (30.0 minutes vs 40.0 minutes, p=0.005) compared with conventional ESD. In addition, ESTD reduced the rate of muscular injury, although there was no statistical difference in the adverse events.…”