Aims Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality
for superficial esophageal lesions although experience in the West is limited. The
aim of this study was to analyze the effectiveness, safety and long-term outcomes
of ESD for esophageal superficial lesions.
Methods Retrospective cohort including consecutive patients submitted to ESD for esophageal
superficial lesions at a tertiary oncology hospital between 2013 and 2022.
Results ESD was performed in 30 lesions (28 patients), with a median lesion size of 2.5cm
[interquartile range (IQR) 1.5-3.0]. Intraprocedural bleeding rate was 30%. There
were no cases of perforation (immediate or delayed) nor of post-procedural bleeding.
Two patients (resections >50% circumference) developed stricture (6.7%) requiring
dilatation. The en bloc and R0 resection rates were 100% and 87%, respectively. Histologically,
20(67%) patients had squamous cell carcinoma, 9 (30%) squamous high-grade dysplasia
and 1(3%) adenocarcinoma. According to the ESGE 2022 recommendations, 20 (67%) lesions
were classified as very low risk, 1 (3%) as low risk, 2 (7%) as local risk and 7 (23%)
as high risk for lymph node metastasis. Thus, one patient undergone radiotherapy,
3 chemoradiotherapy and 3 esophagectomy. During a median follow-up period of 47 months
(IQR 16-79)months, 3 patients developed metachronous lesions and 1 local recurrence.
One patient died from disease progression and 2 patients died from esophagectomy complications.
Conclusions Esophageal ESD is a minimally invasive technique, with a very low rate of adverse
events and avoiding more invasive treatments in 2/3 of the patients.
