Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms

Mitsuhiro Fujishiro, Naohisa Yahagi, Naomi Kakushima, Shinya Kodashima, Yosuke Muraki, Satoshi Ono, Nobutake Yamamichi, Ayako Tateishi, Yasuhito Shimizu, Masashi Oka, Keiji Ogura, Takao Kawabe, Masao Ichinose, Masao Omata

Research output: Contribution to journalArticle

269 Citations (Scopus)

Abstract

Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squamous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100% (58/58), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 78% (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9%) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16%) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 31 patients fulfilling the criteria of node-negative tumors (mean follow-up, 17 months), 1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.

Original languageEnglish
Pages (from-to)688-694
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume4
Issue number6
DOIs
Publication statusPublished - 2006 Jun
Externally publishedYes

Fingerprint

Squamous Cell Neoplasms
Esophageal Neoplasms
Esophagus
Stomach Neoplasms
Esophageal Stenosis
Neoplasms
Carcinoma in Situ
Endoscopic Mucosal Resection
Dilatation
Hemorrhage
Carcinoma

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms. / Fujishiro, Mitsuhiro; Yahagi, Naohisa; Kakushima, Naomi; Kodashima, Shinya; Muraki, Yosuke; Ono, Satoshi; Yamamichi, Nobutake; Tateishi, Ayako; Shimizu, Yasuhito; Oka, Masashi; Ogura, Keiji; Kawabe, Takao; Ichinose, Masao; Omata, Masao.

In: Clinical Gastroenterology and Hepatology, Vol. 4, No. 6, 06.2006, p. 688-694.

Research output: Contribution to journalArticle

Fujishiro, M, Yahagi, N, Kakushima, N, Kodashima, S, Muraki, Y, Ono, S, Yamamichi, N, Tateishi, A, Shimizu, Y, Oka, M, Ogura, K, Kawabe, T, Ichinose, M & Omata, M 2006, 'Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms', Clinical Gastroenterology and Hepatology, vol. 4, no. 6, pp. 688-694. https://doi.org/10.1016/j.cgh.2006.03.024
Fujishiro, Mitsuhiro ; Yahagi, Naohisa ; Kakushima, Naomi ; Kodashima, Shinya ; Muraki, Yosuke ; Ono, Satoshi ; Yamamichi, Nobutake ; Tateishi, Ayako ; Shimizu, Yasuhito ; Oka, Masashi ; Ogura, Keiji ; Kawabe, Takao ; Ichinose, Masao ; Omata, Masao. / Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms. In: Clinical Gastroenterology and Hepatology. 2006 ; Vol. 4, No. 6. pp. 688-694.
@article{a8dfd2c2537d48068c90595e54b58b2a,
title = "Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms",
abstract = "Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squamous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100{\%} (58/58), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 78{\%} (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9{\%}) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16{\%}) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 31 patients fulfilling the criteria of node-negative tumors (mean follow-up, 17 months), 1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.",
author = "Mitsuhiro Fujishiro and Naohisa Yahagi and Naomi Kakushima and Shinya Kodashima and Yosuke Muraki and Satoshi Ono and Nobutake Yamamichi and Ayako Tateishi and Yasuhito Shimizu and Masashi Oka and Keiji Ogura and Takao Kawabe and Masao Ichinose and Masao Omata",
year = "2006",
month = "6",
doi = "10.1016/j.cgh.2006.03.024",
language = "English",
volume = "4",
pages = "688--694",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Endoscopic Submucosal Dissection of Esophageal Squamous Cell Neoplasms

AU - Fujishiro, Mitsuhiro

AU - Yahagi, Naohisa

AU - Kakushima, Naomi

AU - Kodashima, Shinya

AU - Muraki, Yosuke

AU - Ono, Satoshi

AU - Yamamichi, Nobutake

AU - Tateishi, Ayako

AU - Shimizu, Yasuhito

AU - Oka, Masashi

AU - Ogura, Keiji

AU - Kawabe, Takao

AU - Ichinose, Masao

AU - Omata, Masao

PY - 2006/6

Y1 - 2006/6

N2 - Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squamous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100% (58/58), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 78% (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9%) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16%) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 31 patients fulfilling the criteria of node-negative tumors (mean follow-up, 17 months), 1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.

AB - Background & Aims: Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of stomach neoplasms, which results in high tumor eradication rates as well as a modality for the precise histologic assessment of the entire lesion. Application of the technique is desirable for esophageal squamous cell neoplasms (SCNs), but there have been no reports on the use of this procedure in the esophagus. Methods: An ESD with methods similar to those used for resections of early gastric cancer was performed on 58 consecutive esophageal SCNs with preoperative diagnoses of intraepithelial neoplasm or intramucosal invasive carcinoma occurring in 43 enrolled patients. The therapeutic efficacy, complications, and follow-up results were assessed. Results: The rate of en bloc resection was 100% (58/58), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 78% (45/58). There was no evidence of significant bleeding. Perforation occurred in 4 (6.9%) patients during the ESD, who were managed by conservative medical treatments after endoscopic closure of the perforation. Removal of 9 (16%) lesions resulted in esophageal stricture requiring balloon dilation after ESD. Of 40 lesions occurring in 31 patients fulfilling the criteria of node-negative tumors (mean follow-up, 17 months), 1 lesion resected by en bloc resection with nonevaluable tumor-free lateral margins (Rx [lateral] resection) recurred locally 6 months after ESD, which was treated successfully by a second ESD procedure. Conclusions: The ESD is applicable to the esophagus with promising results, but notification of risk is essential.

UR - http://www.scopus.com/inward/record.url?scp=33744774669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744774669&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2006.03.024

DO - 10.1016/j.cgh.2006.03.024

M3 - Article

C2 - 16713746

AN - SCOPUS:33744774669

VL - 4

SP - 688

EP - 694

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 6

ER -