Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Neoplasms

Jung Soo Park, Young Hoon Youn, Jae Jun Park, Jie-Hyun Kim, Hyojin Park, Jung Soo Park, Young Hoon Youn, Jae Jun Park, Jie-Hyun Kim, Hyojin Park

Abstract

Background/aims: Endoscopic treatment has been broadly applied to superficial esophageal neoplasms. Endoscopic submucosal dissection (ESD) allows for high rates of en bloc resection, precise histological assessment, and low rates of local recurrence. The aim of this study was to evaluate the outcomes of ESD for superficial esophageal neoplasms.

Methods: We retrospectively reviewed 36 esophageal ESDs for superficial squamous neoplasms in 32 patients between March 2009 and August 2014 at Gangnam Severance Hospital.

Results: The median patient age was 64 years, and 30 men were included. The indications were early squamous cell carcinoma in 26 lesions, adenoma with high-grade dysplasia in five lesions, and low-grade dysplasia in five lesions. The en bloc resection and R0 resection rates were 97.2% (35 of 36) and 91.7% (33 of 36), respectively. Microperforation and post-ESD bleeding occurred in 5.6% (2 of 36) and 5.6% (2 of 36), respectively. Post-ESD esophageal strictures developed in five patients (13.9%). Five patients (15.6%) had an additional treatment after ESD (concurrent chemoradiation therapy in three, radiation therapy in one, and surgery in one patient). There was no disease-specific mortality during the median follow-up of 31 months.

Conclusions: Favorable clinical outcomes were observed in ESD for superficial esophageal squamous neoplasms. Esophageal ESD could be a good treatment option in terms of efficacy and safety.

Keywords: Carcinoma, squamous cell; Complications; Endoscopic submucosal dissection; Esophageal neoplasms; Treatment outcome.

Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Endoscopic submucosal dissection of a superficial squamous cell carcinoma. (A, B) A slightly erythematous, flat lesion that is not stained with Lugol’s solution. (C, D) Submucosal dissection is made with a dual-knife after local submucosal injection. (E, F) The lesion is completely resected.
Fig. 2.
Fig. 2.
Additional treatment and follow-up of 36 superficial squamous neoplasms in 32 patients who underwent endoscopic submucosal dissection (ESD). RTx, radiotherapy; LN, lymph node; CCRTx, concurrent chemoradiation therapy.

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