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Endoscopic submucosal dissection for superficial esophageal cancer.
Dis Esophagus 2018; 31(7)DE

Abstract

Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality for superficial esophageal cancer. ESD offers a distinct advantage given the ability to perform en bloc resection enabling accurate histopathologic assessment. Data from published literature has established ESD as the preferred option in the treatment of superficial squamous cell carcinoma with complete resection rates of 78-100%, and a low rate recurrence of 0-2.6%. En bloc resection for esophageal SCC is curative for tumors with M1 (intrapethelial) or M2 (invasion into the lamina propria) involvement with no lymphovascular invasion. Tumors that contain lymphovascular invasion or submucosal invasion greater than 200 μm should be treated as advanced carcinomas due to the increased risk of lymph node metastasis. In contrast, the role of ESD in Barrett's esophagus is more limited due to the high rate of efficacy of EMR. A randomized control trial comparing EMR and ESD strategies found a higher R0 resection rate for ESD, but no significant difference in complete remission from neoplasia at 3 month follow up. Endoscopic ultrasound (EUS) has a limited role in the evaluation of superficial esophageal cancer. Alternatively, detailed endoscopic assessment along with magnification endoscopy or narrow band imaging, may provide greater utility than EUS. The most common adverse events of ESD in the esophagus include perforation and stricture. Perforation can often be managed by defect closure along with non-operative conservative management. Steroid administration with either topical or local injection can be effective management in stricture prevention. Continued refinement of ESD technique and innovation will overcome some of the current limitations of ESD and enable curative resection of superficial esophageal cancer as an alternative to invasive surgery.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29982386

Citation

Aadam, A A., and S Abe. "Endoscopic Submucosal Dissection for Superficial Esophageal Cancer." Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, vol. 31, no. 7, 2018.
Aadam AA, Abe S. Endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2018;31(7).
Aadam, A. A., & Abe, S. (2018). Endoscopic submucosal dissection for superficial esophageal cancer. Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, 31(7), doi:10.1093/dote/doy021.
Aadam AA, Abe S. Endoscopic Submucosal Dissection for Superficial Esophageal Cancer. Dis Esophagus. 2018 Jul 1;31(7) PubMed PMID: 29982386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic submucosal dissection for superficial esophageal cancer. AU - Aadam,A A, AU - Abe,S, PY - 2018/7/10/pubmed PY - 2018/11/27/medline PY - 2018/7/9/entrez JF - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus JO - Dis. Esophagus VL - 31 IS - 7 N2 - Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality for superficial esophageal cancer. ESD offers a distinct advantage given the ability to perform en bloc resection enabling accurate histopathologic assessment. Data from published literature has established ESD as the preferred option in the treatment of superficial squamous cell carcinoma with complete resection rates of 78-100%, and a low rate recurrence of 0-2.6%. En bloc resection for esophageal SCC is curative for tumors with M1 (intrapethelial) or M2 (invasion into the lamina propria) involvement with no lymphovascular invasion. Tumors that contain lymphovascular invasion or submucosal invasion greater than 200 μm should be treated as advanced carcinomas due to the increased risk of lymph node metastasis. In contrast, the role of ESD in Barrett's esophagus is more limited due to the high rate of efficacy of EMR. A randomized control trial comparing EMR and ESD strategies found a higher R0 resection rate for ESD, but no significant difference in complete remission from neoplasia at 3 month follow up. Endoscopic ultrasound (EUS) has a limited role in the evaluation of superficial esophageal cancer. Alternatively, detailed endoscopic assessment along with magnification endoscopy or narrow band imaging, may provide greater utility than EUS. The most common adverse events of ESD in the esophagus include perforation and stricture. Perforation can often be managed by defect closure along with non-operative conservative management. Steroid administration with either topical or local injection can be effective management in stricture prevention. Continued refinement of ESD technique and innovation will overcome some of the current limitations of ESD and enable curative resection of superficial esophageal cancer as an alternative to invasive surgery. SN - 1442-2050 UR - https://www.unboundmedicine.com/medline/citation/29982386/Endoscopic_submucosal_dissection_for_superficial_esophageal_cancer_ L2 - https://academic.oup.com/dote/article-lookup/doi/10.1093/dote/doy021 DB - PRIME DP - Unbound Medicine ER -