Endoscopic submucosal dissection of esophageal squamous cell neoplasms

Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squalmous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100% (58/58), and en bloc resection with tumor-free lateral/basal margins (RO resection) was 78% (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9%) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16%) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 3:1 patients fulfilling the criteria of node-negative tumors (mean follow-up, :17 months), :1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.