Novel therapeutic thin endoscope facilitates endoscopic submucosal dissection for cervical esophageal cancer involving the pharyngoesophageal junction

The cervical esophagus, especially the pharyngoesophageal junction, is narrow; thus, the movement of the endoscope is severely limited [1] [2]. This region also has strong flexion to the posterior wall; thus, it is occasionally difficult to approach a lesion with a conventional endoscope with an insufficient downward angle. Recently, a novel therapeutic thin endoscope, EG-840TP (Fujifilm, Tokyo, Japan), has been developed. In this endoscope, despite an outer diameter of 7.9 mm, the working channel diameter is 3.2 mm with a downward angle of 160° ([Fig. 1], [Fig. 2]). Herein, we report a case in which this novel endoscope facilitates endoscopic submucosal dissection (ESD) for cervical esophageal cancer involving the pharyngoesophageal junction ([Video 1]).

Fig. 1 Comparison of the novel therapeutic thin endoscope and normal diameter therapeutic endoscope. Left: Novel therapeutic thin endoscope has a 7.9-mm outer diameter and 3.2-mm working channel diameter. Right: Normal diameter therapeutic endoscope with a 9.8-mm outer diameter.

Fig. 2 Comparison of the downward angle of 160° (novel therapeutic thin endoscope) and 90° (conventional endoscope).

Video 1 Endoscopic submucosal dissection for cervical esophageal cancer involving the pharyngoesophageal junction using the novel therapeutic thin endoscope.

A 58-year-old man was referred to our hospital for the treatment of cervical esophageal cancer. The lesion was 50 mm in size, occupied a half circumferential region, and was located on the posterior wall, involving the pharyngoesophageal junction. We decided to perform ESD. Tracheal intubation and general anesthesia without a laryngoscope were performed. The EG-840TP and DualKnifeJ (Olympus Medical Systems, Tokyo, Japan) were used. ESD was performed in underwater conditions according to the following procedure: 1) mucosal incision and trimming of the distal side to create an endpoint, 2) a full circumferential incision, 3) dissection of both lateral edges of the submucosa, and 4) submucosal dissection of the central area [3]. During the entire procedure, maneuverability and approachability were maintained well. Finally, en bloc resection was achieved without any adverse events ([Fig. 3]).

Fig. 3 Case description. a The lesion was 50 mm in size, occupied half the circumferential area, and was located on the posterior wall. b During the entire procedure, maneuverability and approachability were maintained well. c Wound of the endoscopic submucosal dissection. d En bloc resection was achieved. The procedure time was 100 min and the specimen size was 62 × 37 mm. The pathological diagnosis was squamous cell carcinoma, T1a, with a free horizontal and vertical margin.

We were able to perform successful cervical esophageal ESD due to this novel endoscope. The thin outer diameter allows for free movement even in a narrow space and the sufficient downward angle improves approachability ([Fig. 4]). This novel endoscope may open up new possibilities for endoscopic treatment by enabling movements that were not possible before.

Fig. 4 Illustration of cervical esophageal endoscopic submucosal dissection in conventional endoscope and novel therapeutic thin endoscope. a A conventional endoscope. The pharyngoesophageal junction is narrow and tortuous, thus maneuverability and approachability are poor. b Novel therapeutic thin endoscope. Thin outer diameter allows for free movement even in the narrow space (red circle). c Sufficient downward angle also improves the approachability (blue circle).

Endoscopy_UCTN_Code_TTT_1AO_2AC

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Ariyoshi R, Toyonaga T, Tanaka S. et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms extending to the cervical esophagus. Endoscopy 2018; 50: 613-617
• 2 Iizuka T, Kikuchi D, Hoteya S. et al. Efficacy and safety of endoscopic submucosal dissection for superficial cancer of the cervical esophagus. Endosc Int Open 2017; 5: E736-E741
• 3 Masunaga T, Kato M, Yahagi N. Successful endoscopic submucosal dissection using the water pressure method for cervical esophageal cancer. Dig Endosc 2021; 33: e93-e94

Publication History

Article published online:
11 April 2023