Optimal selection of endoscopic resection in patients with esophageal squamous cell carcinoma: endoscopic mucosal resection versus endoscopic submucosal dissection according to lesion size

Kawashima, Kazumasa; Abe, Seiichiro; Koga, M; Nonaka, Satoru; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Oda, Ichiro; Hikichi, Takuto; Ohira, Hiromasa; Saito, Yutaka

doi:10.1093/dote/doaa096

Cited by 20 publications

(15 citation statements)

References 21 publications

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“…In addition, the cumulative local recurrence rate of EMR was significantly higher in the 16–20 mm group than in the ≤15 mm group ( p < 0.01). Thus, ESD is recommended to achieve en bloc resection for lesions measuring 16–20 mm, in view of an accurate pathological evaluation, 24 consistent with the findings of Ishihara et al 25 …”

Section: Resection Methodssupporting

confidence: 77%

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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Section: Resection Methodssupporting

confidence: 77%

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

et al. 2021

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“… 24 Recent clinical practice guidelines from Korea and the European Society for Medical Oncology recommend endoscopic submucosal dissection (ESD) instead of EMR for clinical T1 disease. 25 , 26 Evidence suggests that ESD is effective for larger superficial tumors and has a lower rate of recurrence than EMR, 27 , 28 but availability of EMR and ESD is limited in Ontario.…”

Section: Discussionmentioning

confidence: 99%

Variation in Diagnosis, Treatment, and Outcome of Esophageal Cancer in a Regionalized Care System in Ontario, Canada

et al. 2021

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Key Points Question Was there a uniform approach to diagnosis, staging, and treatment of patients with esophageal cancer after regionalization of thoracic surgery in Ontario, Canada? Findings In this cohort study of 10 364 patients, there was significant variation in use of staging tests as well as approach to treatment. Postoperative 30- and 90-day mortality was found to be reduced at high-volume centers. Meaning Despite regionalization of thoracic surgery, there remains significant variation between centers in the use of staging tests, treatments, and short-term mortality.

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“…EMR and ESD were performed as described previously [ 12 , 13 ]. Briefly, for EMR, saline was injected into the submucosa after marking dots around the lesion.…”

Section: Methodsmentioning

confidence: 99%

“…4,[6][7][8][9][10] Endoscopic procedure EMR and ESD were performed as described previously. 12,13 Briefly, for EMR, saline was injected into the submucosa after marking dots around the lesion. The lesion was suctioned into the cap and resected.…”

Section: Study 2: Clinical Use Of the Ap Mask During Endoscopic Resectionmentioning

confidence: 99%

Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol-Exposure Protection Mask for Esophagogastroduodenoscopy

et al. 2022

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This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility. Methods: In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure. Results:In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients. Conclusion:The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

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Optimal selection of endoscopic resection in patients with esophageal squamous cell carcinoma: endoscopic mucosal resection versus endoscopic submucosal dissection according to lesion size

Cited by 20 publications

References 21 publications

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

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

Variation in Diagnosis, Treatment, and Outcome of Esophageal Cancer in a Regionalized Care System in Ontario, Canada

Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol-Exposure Protection Mask for Esophagogastroduodenoscopy

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