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. 2014 Nov;8(6):612-8.
doi: 10.5009/gnl13130. Epub 2014 Nov 15.

Long-term outcome after endoscopic submucosal dissection in patients with superficial esophageal squamous cell carcinoma: a single-center study

Dong Chan Joo  1 , Gwang Ha Kim  1 , Do Youn Park  2 , Joon Hyung Jhi  1 , Geun Am Song  1
Affiliations

Long-term outcome after endoscopic submucosal dissection in patients with superficial esophageal squamous cell carcinoma: a single-center study

Dong Chan Joo et al. Gut Liver. 2014 Nov.

Abstract

Background/aims: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs.

Methods: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated.

Results: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively.

Conclusions: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.

Keywords: Endoscopic submucosal dissection; Esophageal neoplasms; Outcome; Squamous cell carcinoma.

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Figures

Fig. 1
Fig. 1
Endoscopic submucosal dissection of a superficial esophageal squamous cell carcinoma. (A) A reddish, ambiguous lesion is seen in the lower esophagus. (B) After chromoendoscopy with iodine staining, marking dots are made to demarcate the lesion. (C) A complete circumferential incision is made using a hook knife. (D) Submucosal dissection is made using an insulated-tip knife. (E) The lesion is completely removed. (F) Resected specimen after iodine staining.
Fig. 2
Fig. 2
Follow-up profile of 28 superficial esophageal squamous cell carcinomas (SESCCs) in 27 patients who underwent endoscopic submucosal dissection (ESD).
Fig. 3
Fig. 3
Survival rates of patients who underwent endoscopic submucosal dissection (ESD) for superficial squamous cell carcinoma. (A) Overall survival rate. (B) Disease-specific survival rate.
See this image and copyright information in PMC

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