Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Satoshi Ono, Mitsuhiro Fujishiro, Keiko Niimi, Osamu Goto, Shinya Kodashima, Nobutake Yamamichi, Masao Omata

Research output: Contribution to journalArticle

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Abstract

Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Design and Setting: Retrospective study from a single institution. Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. Results: The rates of en bloc resection and complete resection were 100% and 88%, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively. Limitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.

Original languageEnglish
Pages (from-to)860-866
Number of pages7
JournalGastrointestinal Endoscopy
Volume70
Issue number5
DOIs
Publication statusPublished - 2009 Nov
Externally publishedYes

Fingerprint

Squamous Cell Neoplasms
Esophageal Neoplasms
Mucous Membrane
Carcinoma
Pathologic Constriction
Endoscopic Mucosal Resection
Retrospective Studies
Observation
Mediastinal Emphysema
Esophageal Stenosis
Survival
Carcinoma in Situ
Deglutition Disorders
Dilatation
Survival Rate

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Ono, S., Fujishiro, M., Niimi, K., Goto, O., Kodashima, S., Yamamichi, N., & Omata, M. (2009). Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointestinal Endoscopy, 70(5), 860-866. https://doi.org/10.1016/j.gie.2009.04.044

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. / Ono, Satoshi; Fujishiro, Mitsuhiro; Niimi, Keiko; Goto, Osamu; Kodashima, Shinya; Yamamichi, Nobutake; Omata, Masao.

In: Gastrointestinal Endoscopy, Vol. 70, No. 5, 11.2009, p. 860-866.

Research output: Contribution to journalArticle

Ono, S, Fujishiro, M, Niimi, K, Goto, O, Kodashima, S, Yamamichi, N & Omata, M 2009, 'Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms', Gastrointestinal Endoscopy, vol. 70, no. 5, pp. 860-866. https://doi.org/10.1016/j.gie.2009.04.044
Ono, Satoshi ; Fujishiro, Mitsuhiro ; Niimi, Keiko ; Goto, Osamu ; Kodashima, Shinya ; Yamamichi, Nobutake ; Omata, Masao. / Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 5. pp. 860-866.
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abstract = "Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Design and Setting: Retrospective study from a single institution. Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. Results: The rates of en bloc resection and complete resection were 100{\%} and 88{\%}, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4{\%}) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18{\%}) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100{\%} and 85{\%}, respectively. Limitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.",
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AU - Kodashima, Shinya

AU - Yamamichi, Nobutake

AU - Omata, Masao

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AB - Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Design and Setting: Retrospective study from a single institution. Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. Results: The rates of en bloc resection and complete resection were 100% and 88%, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively. Limitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.

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