Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study

Background and study aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals.

Patients and methods: Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed.

Results: The median tumor size was 18 mm (range 2 – 85 mm). The median procedure time was 90 minutes (range 12 – 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % – 98.1 %) and 84.5 % (95 %CI 80.5 % – 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % – 7.9 %), 1.6 % (95 %CI 0.7 % – 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % – 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 – 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections.

Conclusions: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

• References

• 1 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
• 2 Atkins BZ, Shah AS, Hutcheson KA et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78: 1170-1176
• 3 Shimizu Y, Tsukagoshi H, Fujita M et al. Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper. Gastrointest Endosc 2002; 56: 387-390
• 4 Ishihara R, Iishi H, Uedo N et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 2008; 68: 1066-1072
• 5 Akasaka T, Nishida T, Tsutsui S et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD Study Group. Dig Endosc 2011; 23: 73-77
• 6 Kato M, Nishida T, Yamamoto K et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD Study Group. Gut 2013; 62: 1425-1432
• 7 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-70
• 8 Ono S, Fujishiro M, Niimi K et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
• 9 Tamiya Y, Nakahara K, Kominato K et al. Pneumomediastinum is a frequent but minor complication during esophageal endoscopic submucosal dissection. Endoscopy 2010; 42: 8-14
• 10 Nonaka K, Arai S, Ishikawa K et al. Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms. World J Gastrointest Endosc 2010; 2: 69-74
• 11 Takahashi H, Arimura Y, Masao H et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
• 12 Fujishiro M, Kodashima S, Goto O et al. Endoscopic submucosal dissection for esophageal squamous cell neoplasms. Dig Endosc 2009; 21: 109-115
• 13 Mizuta H, Nishimori I, Kuratani Y et al. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus 2009; 22: 626-631
• 14 Hanaoka N, Ishihara R, Takeuchi Y et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 2012; 44: 1007-1011
• 15 Yamaguchi N, Isomoto H, Nakayama T et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
• 16 Kato M, Gromski M, Jung Y et al. The learning curve for endoscopic submucosal dissection in an established experimental setting. Surg Endosc 2013; 27: 154-161
• 17 Oda I, Odagaki T, Suzuki H et al. Learning curve for endoscopic submucosal dissection of early gastric cancer based on trainee experience. Dig Endosc 2012; 24: 129-132
• 18 Akahoshi K, Honda K, Akahane H et al. Endoscopic submucosal dissection by using a grasping-type scissors forceps: a preliminary clinical study (with video). Gastrointest Endosc 2008; 67: 1128-1133
• 19 Fujinami H, Hosokawa A, Ogawa K et al. Endoscopic submucosal dissection for superficial esophageal neoplasms using the stag beetle knife. Dis Esophagus 2014; 27: 50-54
• 20 Takeuchi Y, Uedo N, Ishihara R et al. Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol 2010; 105: 314-322
• 21 Maeda Y, Hirasawa D, Fujita N et al. A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation. Endoscopy 2012; 44: 565-571
• 22 Akahoshi K, Minoda Y, Komori K et al. Endoscopic submucosal dissection using the “Clutch Cutter” for early esophageal squamous cell carcinoma. Endoscopy 2013; 45: 1035-1038
• 23 Ishihara R, Iishi H, Takeuchi Y et al. Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc 2008; 67: 799-804
• 24 Takahashi H, Arimura Y, Okahara S et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy 2011; 43: 184-189
• 25 Yano T, Yoda Y, Satake H et al. Radial incision and cutting method for refractory stricture after nonsurgical treatment of esophageal cancer. Endoscopy 2013; 45: 316-319
• 26 Oda I, Suzuki H, Nonaka S et al. Complications of gastric endoscopic submucosal dissection. Dig Endosc 2013; 25: 71-78
• 27 Katada C, Muto M, Nakayama M et al. Risk of superficial squamous cell carcinoma developing in the head and neck region in patients with esophageal squamous cell carcinoma. Laryngoscope 2012; 122: 1291-1296
• 28 Iseli TA, Iseli CE, Golden JB et al. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose Throat J 2012; 91: E1-5
• 29 Yamashina T, Ishihara R, Nagai K et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 2013; 108: 544-551
• 30 Akutsu Y, Uesato M, Shuto K et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg 2013; 257: 1032-1038