Endoscopic submucosal dissection using an ultrathin endoscope for superficial pharyngeal cancer: a prospective feasibility study (with video)

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) of pharyngeal cancers with conventional endoscopes often is difficult, not only because of the narrow working space, but also because endoscope maneuverability in the pharynx is poor due to interference from the endotracheal tube and/or hyoid bone. However, we hypothesized that those problems could possibly be resolved by use of an ultrathin endoscope for ESD of superficial pharyngeal cancer. The aim of this prospective interventional study was to investigate the feasibility of ESD for superficial pharyngeal cancer using an ultrathin endoscope.

Patients and methods This feasibility study was conducted at NTT Medical Center Tokyo between June 2020 and September 2021, and data from a total of 20 consecutively superficial pharyngeal cancers were analyzed. The primary outcome measure was the R0 resection rate. The ESD completion rate, en bloc resection rate, procedure time, and frequency of intraoperative and postoperative adverse events (AEs) were also evaluated as secondary outcome measures.

Results Data from 16 patients with 20 lesions were included in the analysis. All of the lesions were successfully resected by ultrathin endoscope ESD, and the en bloc and R0 resection rates were 100 % and 85.0 % (17/20), respectively; the procedure time was 37.8 ± 28.2 minutes. No intraoperative or postoperative AEs were encountered in any cases.

Conclusions ESD using an ultrathin endoscope is feasible for superficial pharyngeal cancers and has potential to be a safe and effective treatment option for these cancers.

Publikationsverlauf

Eingereicht: 18. März 2022

Angenommen nach Revision: 25. Oktober 2022

Accepted Manuscript online:
27. Oktober 2022

Artikel online veröffentlicht:
04. Januar 2023

• References

• 1 Eckel HE, Staar S, Volling P. et al. Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results. Otolaryngol. Head Neck Surg 2001; 124: 561-569
• 2 Johansen LV, Grau C, Overgaard J. Hypopharyngeal squamous cell carcinoma–treatment results in 138 consecutively admitted patients. Acta Oncol 2000; 39: 529-536
• 3 Muto M, Minashi K, Yano T. et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572
• 4 Katada C, Tanabe S, Koizumi W. et al. Narrow band imaging for detecting superficial squamous cell carcinoma of the head and neck in patients with esophageal squamous cell carcinoma. Endoscopy 2010; 42: 185-190
• 5 Kikuchi D, Iizuka T, Yamada A. et al. Utility of magnifying endoscopy with narrow band imaging in determining the invasion depth of superficial pharyngeal cancer. Head Neck 2015; 37: 846-850
• 6 Goda K, Dobashi A, Yoshimura N. et al. Dual-focus versus conventional magnification endoscopy for the diagnosis of superficial squamous neoplasms in the pharynx and esophagus: a randomized trial. Endoscopy 2016; 48: 321-329
• 7 Muto M, Satake H, Yano T. et al. Long-term outcome of transoral organ-preserving pharyngeal endoscopic resection for superficial pharyngeal cancer. Gastrointest Endosc 2011; 74: 477-484
• 8 Satake H, Yano T, Muto M. et al. Clinical outcome after endoscopic resection for superficial pharyngeal squamous cell carcinoma invading the subepithelial layer. Endoscopy 2015; 47: 11-18
• 9 Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006; 41: 929-942
• 10 Iizuka T, Kikuchi D, Hoteya S. et al. Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas. Endoscopy 2009; 41: 113-117
• 11 Kuwabara T, Hiyama T, Oka S. et al. Clinical features of pharyngeal intraepithelial neoplasias and outcomes of treatment by endoscopic submucosal dissection. Gastrointest Endosc 2012; 76: 1095-1103
• 12 Hanaoka N, Ishihara R, Takeuchi Y. et al. Clinical outcomes of endoscopic mucosal resection and endoscopic submucosal dissection as a transoral treatment for superficial pharyngeal cancer. Head Neck 2013; 35: 1248-1254
• 13 Yoshio T, Tsuchida T, Ishiyama A. et al. Efficacy of double-scope endoscopic submucosal dissection and long-term outcomes of endoscopic resection for superficial pharyngeal cancer. Dig Endosc 2017; 29: 152-159
• 14 Iizuka T, Kikuchi D, Suzuki Y. et al. Clinical relevance of endoscopic treatment for superficial pharyngeal cancer: feasibility of techniques corresponding to each location and long-term outcomes. Gastrointest Endosc 2021; 93: 818-827
• 15 Kawai T, Yanagizawa K, Naito S. et al. Evaluation of gastric cancer diagnosis using new ultrathin transnasal endoscopy with narrow-band imaging: preliminary study. J Gastroenterol Hepatol 2014; 29: 33-36
• 16 Suzuki T, Kitagawa Y, Nankinzan R. et al. Early gastric cancer diagnostic ability of ultrathin endoscope loaded with laser light source. World J Gastroenterol 2019; 25: 1378-1386
• 17 Muramoto T, Sakai E, Ohata K. Endoscopic submucosal dissection for superficial hypopharyngeal cancer with thin endoscope. Dig Endosc 2020; 32: e13-14
• 18 Ohata K, Muramoto T, Minato Y. et al. Usefulness of a multifunctional snare designed for colorectal hybrid endoscopic submucosal dissection (with video). Endosc Int Open 2018; 6: E249-E253
• 19 Kobara H, Mori H, Masaki T. Effective and economical endoscopic resection using a novel multifunctional snare for small-sized gastric neoplasms. Dig Endosc 2018; 30: 800-801
• 20 Arimoto J, Ohata K, Chiba H. et al. Evaluation of colorectal endoscopic submucosal dissection using a multifunctional snare: a prospective clinical feasibility study (with videos). Gastrointest Endosc 2021; 93: 671-678
• 21 Kurebayashi M, Sakai E, Suzuki Y. et al. Usefulness of a handmade distal endoscope attachment with a transparent tape. VideoGIE 2020; 5: 226-228
• 22 Tateya I, Muto M, Morita S. et al. Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer. Surg Endosc 2016; 30: 323-329
• 23 Watanabe A, Taniguchi M, Kimura Y. et al. Synopsis of transoral endoscopic laryngopharyngeal surgery for superficial pharyngeal cancers. Head Neck 2017; 39: 1779-1787
• 24 Kinjo Y, Nonaka S, Oda I. et al. The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma. Endosc Int Open 2015; 3: E266-E273
• 25 Okada K, Tsuchida T, Ishiyama A. et al. Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas. Endoscopy 2012; 44: 556-564
• 26 Yagi J, Adachi K, Arima N. et al. A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy 2005; 37: 1226-1231
• 27 Kawai T, Miyazaki I, Yagi K. et al. Comparison of the effects on cardiopulmonary function of ultrathin transnasal versus normal diameter transoral esophagogastroduodenoscopy in Japan. Hepatogastroenterology 2007; 54: 770-774
• 28 Suzuki T, Kitagawa Y, Nankinzan R. et al. Early gastric cancer diagnostic ability of ultrathin endoscope loaded with laser light source. World J Gastroenterol 2019; 25: 1378-1386
• 29 Sato R, Watari J, Tanabe H. et al. Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction. Gastrointest Endosc 2008; 67: 953-957
• 30 Ogata K, Yanai M, Kuriyama K. et al. Double endoscopic intraluminal operation (DEILO) for early gastric cancer: outcome of novel procedure for endoscopic submucosal dissection. Anticancer Res 2017; 37: 343-347
• 31 Grimes KL, Inoue H, Onimaru M. et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc 2016; 30: 1344-1351
• 32 Minato Y, Sakai E, Ohata K. Conscious transnasal hybrid endoscopic submucosal dissection enables safe and painless en bloc resection in elderly patients with early gastric cancer. VideoGIE 2019; 4: 157-158
• 33 Muramoto T, Sakai E, Ohata K. Thin-endoscope endoscopic submucosal dissection for early esophageal cancer with postoperative stricture. Dig Endosc 2020; 32: e11-e12
• 34 Iizuka T, Kikuchi D, Hoteya S. et al. A new technique for pharyngeal endoscopic submucosal dissection: Peroral countertraction (with video). Gastrointest Endosc 2012; 76: 1034-1038
• 35 Matsuno K, Miyamoto H, Tanaka M. Novel traction method for pharyngeal endoscopic submucosal dissection using ring-shaped thread and grasping forceps. Dig Endosc 2020; 32: e120-e121