Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy – a case series

Introduction

One of the hallmarks of esophageal squamous cell carcinoma (ESCC) is the appearance of metachronous tumors in various organs after esophagectomy [1] [2] [3]. Gastric tube cancers (GTCs), defined as gastric cancer arising from the reconstructed gastric tube after esophagectomy, usually remain asymptomatic for a long period and have been typically detected in an advanced stage. However, several reports since the mid-1990s have described successful treatment of GTC by endoscopic mucosal resection (EMR) [2] [4] [5]. Although GTC is fortunately diagnosed as early stage within the EMR criteria [6], problems of location, size, and occasionally piecemeal resection, which are specifically observed in the gastric tube, have been encountered for GTC using EMR procedures.

Endoscopic submucosal dissection (ESD) offers advantages in terms of shape and size of the resected specimen compared with conventional EMR, and has been successfully used for en bloc resection of various cancers [7] [8] [9] [10]. We encountered eight cases of early GTC following detailed surveillance endoscopy using indigo carmine dye after esophagectomy; in most cases the cancer was limited to the mucosal layer. Almost all GTCs were successfully resected en bloc by ESD. This retrospective study clarified the clinicopathological features of GTC and evaluated the utility of applying ESD.

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