OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY ESOPHAGEAL SQUAMOUS CELL NEOPLASIA AT A WESTERN CENTER

Aims:

Endoscopic submucosal dissection has become the gold standard for the management of early esophageal squamous cell carcinoma (ESCC) as a staging procedure and curative treatment. However, data from Western centers are scarce.

Methods:

We conducted a retrospective study from a prospectively collected database at a tertiary care center in France. Patients’ characteristics, procedural data, histology results, early and late complications were recorded. All consecutive patients undergoing endoscopic submucosal dissection for ESCC were included. Main outcome measurement was the curative resection rate. Secondary outcome measurements were en bloc resection rates, histologically complete resection rates, and recurrence-free and overall survival.

Results:

From 2012 to 2016, 56 SCC (49 patients; mean age 61.5 ± 10 years; 36 men) were included. En bloc resection, histologically complete resection, and curative resection rate were 98%, 91%, and 71% respectively. Fifteen (30%) patients received an additional treatment after ESD, of which 5 (33%) experienced recurrence. After a mean follow-up of 21.2 ± 14.8 months, 10 (18%) patients experienced recurrence and 8 (16.3%) died, of which 2 (4%) from esophagealcancer. Factors significantly associated with mortality in this series were: a moderately or poorly differentiated ESCC (p = 0.02) and a recurrence of ESCC (p = 0.028).

Conclusions:

Endoscopic submucosal dissection of ESCC yields comparable results in Europe and Japan. Moderately or poorly differentiated cancer is a major prognostic factor and should probably be taken into account when indicating an additional treatment after ESD. Close endoscopic follow-up is essential considering the high recurrence rate.