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Review
. 2021 Sep 20;2(1):e45.
doi: 10.1002/deo2.45. eCollection 2022 Apr.

Endoscopic resection of esophageal squamous cell carcinoma: Current indications and treatment outcomes

Seiichiro Abe  1 , Yuichiro Hirai  1 , Takeshi Uozumi  1 , Mai Ego Makiguchi  1 , Satoru Nonaka  1 , Haruhisa Suzuki  1 , Shigetaka Yoshinaga  1 , Ichiro Oda  1   2 , Yutaka Saito  1
Affiliations
Review

Endoscopic resection of esophageal squamous cell carcinoma: Current indications and treatment outcomes

Seiichiro Abe et al. DEN Open. .

Abstract

Endoscopic resection (ER) is an alternate minimally invasive treatment for superficial esophageal squamous cell carcinoma (SESCC). We aimed to review the clinical indications and treatment outcomes of ER for SESCC. Endoscopic mucosal resection is relatively easy and efficient for SESCC ≤ 15 mm. In contrast, endoscopic submucosal dissection (ESD) is recommended to achieve en bloc resection for lesions >15 mm, in view of the accurate pathological evaluation. The Japan Gastroenterological Endoscopy Society guidelines recommend ER for non-circumferential cT1a-EP/LPM (epithelium/lamina propria mucosae), cT1a-MM/T1b-SM1 (muscularis mucosa/superficial submucosa ≤ 200μm) SESCC, and whole-circumferential T1a-EP/LPM SESCC ≤ 50 mm (upon implementing preventive measures for stenosis), considering the risk-benefit balance of ER. It defines pT1a-EP/LPM without lymphovascular invasion as a curative endoscopic resection. The guidelines recommend additional esophagectomy or chemoradiotherapy for pT1b SESCC or any SESCC, with lymphovascular invasion. However, there is no recommendation for or against the administration of additional treatments for pT1a-MM without lymphovascular invasion, owing to limited evidence. Researchers have reported on high en bloc and R0 resection rates of ESD, and a randomized controlled trial demonstrated that clip-line traction-assisted ESD could significantly reduce the ESD procedural time. Moreover, steroid treatment has been developed to prevent post-ESD esophageal strictures. There have been reports on favorable long-term outcomes of ESD. However, most of them are retrospective studies. Further robust data in prospective trials are warranted to achieve a definitive evidence of ESD, which will be beneficial to patients with SESCC.

Keywords: endoscopic mucosal resection; endoscopic resection; endoscopic submucosal dissection; esophageal cancer; squamous cell carcinoma.

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Conflict of interest statement

Seiichiro Abe is an associate editor of DEN Open. The rest of the authors have no conflict of interest.National Cancer Center Research and Development Fund, Grant/Award Numbers: 2020‐A‐4, 2020‐A‐12.

Figures

FIGURE 1
FIGURE 1
Endoscopic mucosal resection. (a) Chromoendoscopy with iodine staining indicates a shallow depressed iodine‐unstained lesion in the left wall of the upper thoracic esophagus. (b) Endoscopic marking. (c) A crescent snare has been pre‐looped on the edge of an oblique endocap. (d) The lesion has been resected with a pre‐looped snare after being suctioned into the endocap. (e) The mucosal defect. (f) Histological examination of the resected specimen reveals squamous cell carcinoma, 5 mm × 4 mm, 0‐IIc, pT1a‐LPM, INFa, ly(‐), v(‐), pHM0, pVM0
FIGURE 2
FIGURE 2
Endoscopic submucosal dissection. (a) Chromoendoscopy with iodine staining indicates a shallow depressed iodine‐unstained lesion in the left wall of the middle thoracic esophagus. (b) Endoscopic marking. (c) C‐shaped mucosal incision. (d) Submucosal dissection with the insulated tip knife. (e) C‐shaped submucosal dissection. (f) Circumferential mucosal incision. (g) Clip line traction method: The submucosal space has been opened well, with satisfactory tissue traction. (h) The mucosal defect. (i) The resected specimen. (j) The resected specimen reveals squamous cell carcinoma, 42 mm × 26 mm, 0‐IIc, pT1a‐LPM, INFa, ly(‐), v(‐), pHM0, pVM0
FIGURE 3
FIGURE 3
Clinical indications for the endoscopic resection of superficial esophageal squamous cell carcinoma and curability assessment (published in Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer22). (a) Clinical indications for endoscopic resection for superficial esophageal squamous cell carcinoma cT1aEP/lamina propria mucosae. (b) Clinical indications for endoscopic resection of superficial esophageal squamous cell carcinoma cT1a‐MM/T1b‐SM1. (c) Curability assessment
See this image and copyright information in PMC

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