Updates on endoscopic therapy of esophageal carcinoma

Abstract

Endoscopic submucosal dissection (ESD) has the advantage over endoscopic mucosa resection (EMR), permitting removal of gastrointestinal neoplasms en bloc, but is associated with a relatively high risk of complications. Early esophageal cancer (EEC) is indicated when the tumors are confined to the two-third layer of the lamina propria. Esophageal stricture following semicircular or complete circular esophageal ESD is relatively frequent even if treated by multiple pre-emptive endoscopic balloon dilatation. Oral prednisolone may offer a novel, safe, and effective option for prevention of post-ESD stricture associated with ESD for extensive esophageal neoplasms. The procedures include marking, submucosal injection, circumferential mucosal incision and exfoliation of the lesion along the submucosal layer. Complete ESD can achieve a large one-piece resection, allowing precise histological assessment to prevent recurrence. Clinical outcomes of esophageal ESD have been promising, and the prognosis of EEC patients treated by ESD is likely to be excellent, though further long-term follow-up studies are warranted. Notification of a risk of perforation is essential for esophageal ESD. Bleeding during ESD can be managed with coagulation forceps, and postoperative bleeding may be reduced with routine use of the stronger acid suppressant, proton pump inhibitors.

Keywords: Barrett's adenocarcinoma; early esophageal cancer; endoscopic mucosal resection; endoscopic submucosal dissection; squamous cell carcinoma.