Salvage endoscopic submucosal dissection for incompletely resected esophageal or gastric neoplasms (case series)

Abstract

Background and study aims Given that positive lateral margins indicate possible residual carcinoma, salvage endoscopic submucosal dissection (ESD) should be considered for curative therapy. Presence of submucosal fibrosis, however, makes the procedure difficult to perform. We present our case series to discuss the feasibility of salvage ESD and the timing of the procedure.

Fig. 1

Degree of fibrosis during ESD. Case 1, F0 (none); Case 2, F1 (mild); Cases 3 – 6, F2 (severe).

Fig. 2

Case 1: superficial esophageal cancer. a A type 0-II c superficial esophageal cancer was observed in the middle of the thoracic esophagus. Arrows indicate the lesion. b Lugol staining. c Histological examination of the resected specimen revealed intraepithelial squamous cell carcinoma with a positive horizontal margin. d ESD-induced ulcer. e Lugol staining. f We performed salvage ESD after 15 days. Vertical and horizontal margins were both negative.

Fig. 3

Case 3: early gastric cancer. a A superficial elevated 24-mm lesion was observed in the lesser curvature of the upper stomach. b Acetic acid-indigo carmine chromoendoscopy. c Histological examination of the resected specimen revealed a well-differentiated mucosal adenocarcinoma with a positive horizontal margin. d ESD-induced ulcer. e Acetic acid-indigo carmine chromoendoscopy. f We performed salvage ESD after 35 days. Vertical and horizontal margins were both negative.