Patients with squamous cell carcinoma (SCC) of the esophagus must be screened for
synchronous and metachronous lesions of the head and neck during surveillance. Screening
by head and neck surgeons is performed using high definition resolution (HDR) endoscopy
and narrow-band imaging (NBI), which aid considerably in the detection of superficial
lesions.
Endoscopic submucosal dissection (ESD) of superficial head and neck carcinomas is
feasible and allows accurate pathological analysis to confirm its efficiency, in contrast
to the traditional destructive therapy usually performed by otorhinolaryngology surgeons.
However, ESD is particularly challenging in this location [1]
[2] because of the narrow lumen and the difficulty of handling a scope in close proximity
to the dental line. A countertraction strategy [3] has recently been reported as a technical help for this location.
Here we report a successful case of ESD for a superficial SCC of the pharynx. The
lesion was diagnosed using NBI during ESD for an SCC of the esophagus ([Fig. 1]). NBI allows clear identification of abnormalities of vascular and mucosal patterns.
The margins were delineated before resection using NBI chromoendoscopy, dual focus,
and Lugol vital coloration. ESD was performed by the tunnel and clip method [4] using a dual knife and with injection of a glycerol solution allowing a constant
exposure of the submucosal space, which facilitated the procedure in this challenging
location ([Fig. 2] and [Fig. 3]; [Video 1]). The patient was extubated 24 hours after ESD to avoid immediate post-ESD pharyngeal
edema. Pathological analysis showed an in situ SCC with tumor-free deep and lateral
margins.
Fig. 1 A superficial lesion in the pharynx is visualized: a on white-light imaging; b on narrow-band imaging (NBI); c using Lugol dye.
Fig. 2 Views during endoscopic submucosal dissection (ESD) of the pharyngeal lesion showing:
a creation of the tunnel; b clip countertraction at the end of the tunnel; c ESD of the lateral edge of the tunnel; d the area following resection.
Fig. 3 Macroscopic appearance of the resected specimen.
Video 1: Endoscopic submucosal dissection (ESD) being performed on a pharyngeal superficial
squamous cell carcinoma using the tunnel and clip technique.
HDR endoscopy, NBI, and dual focus are useful tools that permit the detection of very
early pharyngeal SCC. Flexible endoscopy can be used to accurately analyze this area
and increase the detection of treatable lesions in high risk patients. While ESD of
the pharynx is technically challenging, it is feasible; the tunnel and clip strategy
facilitates the procedure and enables a conservative and curative resection.
Endoscopy_UCTN_Code_TTT_1AO_2AC
