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CC BY-NC-ND 4.0 · Endoscopy 2023; 55(S 01): E731
DOI: 10.1055/a-2068-7664
E-Videos

Transgastrostomy retrograde endoscopic submucosal dissection of esophageal squamous cell carcinoma

Julia Mayumi Gregorio
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
Deborah Marques Centeno
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
Rafael Utimura Sueta
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
Pastor Joaquin Ortiz Mendieta
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
João Guilherme Ribeiro Jordão Sasso 
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
Bruno Costa Martins 
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
,
Fauze Maluf-Filho 
Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
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Patients undergoing treatment for laryngeal cancer are often treated with total laryngectomy, with about 11 % of patients developing a postoperative stricture [1]. Patients with head and neck tumors also develop esophageal squamous cell carcinoma (ESCC) in 5 %–10 % of cases [2]. Endoscopic submucosal dissection (ESD) is indicated for the treatment of early ESCC; however, transoral ESD is not possible in patients with recalcitrant pharyngoesophageal stricture [3]. In this case report, we demonstrate an alternative strategy for this situation.

A 60-year-old man with laryngeal squamous cell carcinoma (T4aN3bM0) underwent total laryngectomy with radical neck dissection and neopharyngeal reconstruction with a microsurgical flap, followed by adjuvant radiotherapy. He developed a long stricture (8 cm) of the myocutaneous flap and a percutaneous endoscopic gastrostomy was performed. He underwent multiple endoscopic dilation sessions (using Savary–Gilliard and balloon dilators).

During these procedures, a pale flat lesion (Paris 0-IIb) with high grade dysplasia, measuring 15 mm, was diagnosed at 29 cm from the incisors. Even after multiple dilation sessions, only a slim scope (4.9 mm) could traverse the stenosis. Therefore, a retrograde ESD was performed, introducing the endoscope through the gastrostomy orifice ([Video 1]). The orifice was balloon dilated to 12 mm. With the patient under general anesthesia, the procedure was performed using a 2.0-mm DualKnife (Olympus Inc.) with submucosal injection of a 6 % hydroxyethyl starch (HES) solution with indigo carmine.

Video 1 Transgastrostomy retrograde endoscopic submucosal dissection of esophageal squamous cell carcinoma.


Quality:

The procedure duration was 60 minutes and no adverse events occurred. Histology of the resected specimen revealed high grade dysplasia, an absence of invasive neoplasm, and tumor-free margins. The patient had an uneventful recovery.

Endoscopy_UCTN_Code_CPL_1AH_2AZ

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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Thompson CSG, Asimakopoulos P, Evans A. et al. Complications and predisposing factors from a decade of total laryngectomy. J Laryngol Otol 2020; 134: 256-262
    CrossrefPubMedSearch in Google Scholar
  • 2 Thakur K, Singh CA, Thakar A. et al. Prevalence of synchronous ESCN in head and neck cancer: a single-institution perspective. Laryngoscope 2021; 131: E807-E814
    CrossrefPubMedSearch in Google Scholar
  • 3 Kobayashi Y, Nishikawa K, Akasaka T. et al. Retrograde endoscopic submucosal dissection for early thoracic esophageal carcinoma. Clin J Gastroenterol 2021; 14: 434-438
    CrossrefPubMedSearch in Google Scholar

Corresponding author

Julia Mayumi Gregorio, MD
Department of Gastroenterology
Instituto do Câncer do Estado de São Paulo – ICESP
Av Dr Arnaldo 251
São Paulo
Brazil   

Publication History

Article published online:
26 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Thompson CSG, Asimakopoulos P, Evans A. et al. Complications and predisposing factors from a decade of total laryngectomy. J Laryngol Otol 2020; 134: 256-262
    CrossrefPubMedSearch in Google Scholar
  • 2 Thakur K, Singh CA, Thakar A. et al. Prevalence of synchronous ESCN in head and neck cancer: a single-institution perspective. Laryngoscope 2021; 131: E807-E814
    CrossrefPubMedSearch in Google Scholar
  • 3 Kobayashi Y, Nishikawa K, Akasaka T. et al. Retrograde endoscopic submucosal dissection for early thoracic esophageal carcinoma. Clin J Gastroenterol 2021; 14: 434-438
    CrossrefPubMedSearch in Google Scholar

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