Endoscopic Submucosal Dissection for superficial esophageal malignant lesions in a Western tertiary center

Aims Esophageal cancer, primarily in the forms of squamous cell carcinoma (SCC) and adenocarcinoma (ACC), is highly aggressive with a poor prognosis and high mortality rate. Treatments for advanced cases, like surgery and chemoradiotherapy, are invasive and associated with significant risks and adverse events. Detection rates are increasing, allowing many superficial lesions to be treated endoscopically, particularly with endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy and safety of ESD in treating esophageal lesions.

Methods A retrospective analysis of all esophageal ESD performed between April 2018 and July 2024 at a Western tertiary center was performed. Clinical, procedural and histopathological data were recorded. All non-malignant lesions confirmed histologically after resection were excluded.

Results A total of 20 lesions in 19 patients were evaluated. Most patients were male (84.21%) with a median age of 68 years (IQR 14.00). The majority of resected lesions were SCC (n=15; 75%) and the remaining were ACC (n=5; 25%). The median lesion size was 25.00 mm (IQR 46.50), and the median resected specimen size was 57.50 mm (IQR 54.25). En bloc resection and R0 resection rates were 100% for both SCC and ACC. Overall, the curative resection rate with ESD was 70% (100% for ACC and 60% for SCC). Despite prophylactic measures (oral prednisolone+/- injectable triamcinolone), stenosis post-ESD developed in 9 cases (7 after ESD of circumferential lesions and 2 in lesions involving three-quarters of the luminal circumference). There was a higher risk of stenosis in lesions larger than 30 mm (p=0.03) and in specimens with longitudinal resections of 50 mm or more (p=0.04). There was no delayed bleeding or perforation after ESD. During follow-up, two patients died (one of them due to metastasized SCC and the other due to lung cancer).

Conclusions This study confirms the technical success and safety of ESD in treating superficial esophageal malignancies. While ESD demonstrates promising outcomes, curative resection of SCC remains challenging. The relatively high rate of stenosis observed was due to the degree of circumferential involvement. Enhancing stenosis prevention could significantly improve quality of life for these patients.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025