Minimally invasive retrograde esophageal endoscopic submucosal dissection via gastrostomy using a thin therapeutic endoscope

A 58-year-old woman with dysphagia was diagnosed with advanced esophageal cancer. She achieved complete response with definitive chemoradiotherapy, but cervical esophageal stenosis occurred ([Fig. 1]). A percutaneous endoscopic gastrostomy was performed for nutritional support. Endoscopic balloon dilation was performed; however, the stricture was refractory, and a standard-caliber endoscope could not pass even after dilation. After dilation, a transnasal endoscope passed through the stricture, and a superficial esophageal carcinoma (Lt/Rw, 0-IIc + IIa, cT1a-MM, 14 mm) was identified distal to the stricture ([Fig. 2]).

Fig. 1 Cervical esophageal stenosis occurred after definitive chemoradiotherapy for advanced esophageal cancer. A standard-caliber transoral endoscope could not pass through.

Fig. 2 A superficial esophageal carcinoma (Lt/Rw, 0-IIc + IIa, cT1a-MM, 14 mm) identified during dilation for cervical esophageal stenosis.

As passage through the stricture with a standard-caliber endoscope was difficult, retrograde endoscopic submucosal dissection (ESD) via gastrostomy was planned. A thin therapeutic endoscope (EG-840TP; FUJIFILM) was inserted through the gastrostomy without dilation, and successfully provided retrograde access to the esophageal lumen ([Fig. 3]). Using an ITknife nano (OLYMPUS), ESD was performed without intraoperative complications, and en bloc resection was achieved ([Fig. 4], [Video 1]). The pathological diagnoses were as follows: squamous cell carcinoma, pT1a-MM, ly0, v0, pHM0, pVM0, and 11 × 10 mm. No local recurrence was observed at 18 months after ESD.

Fig. 3 a and b The EG-840TP (FUJIFILM) is a thin endoscope with an outer diameter of 7.9 mm and a working channel of 3.2 mm, allowing the use of standard therapeutic devices. c A thin therapeutic endoscope was inserted through the gastrostomy without dilation for retrograde esophageal access.

Fig. 4 a Circumferential marking was performed. b Post-ESD ulcer after en bloc resection via a retrograde approach using a thin therapeutic endoscope, with no intraoperative complications.

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Retrograde ESD via gastrostomy using a thin therapeutic endoscope achieved en bloc resection of a superficial esophageal carcinoma distal to the stricture, without gastrostomy dilation.Video 1

Retrograde esophageal ESD via gastrostomy, using a standard-caliber therapeutic scope, is a valuable option for patients with difficult transoral insertion, although gastrostomy dilation was required in previous reports [1] [2]. Recent studies have also demonstrated the usefulness of thin therapeutic endoscopes in anatomically challenging situations, such as post-treatment esophageal strictures, where conventional scopes are difficult to use [3] [4] [5]. In this case, because the cervical esophageal stricture existed, the lesion was successfully resected via a retrograde approach using a thin therapeutic endoscope, and without requiring gastrostomy dilation.

A thin therapeutic endoscope enables the use of standard ESD devices and eliminates the need for gastrostomy dilation, thereby simplifying the procedure. This minimally invasive approach may represent a viable therapeutic option for superficial esophageal cancer with severe esophageal strictures.

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Contributorsʼ Statement

Tetsuhiko Hirai: Writing – original draft. Yoichi Yamamoto: Writing – original draft. Masao Yoshida: Writing – review & editing. Noboru Kawata: Writing – review & editing. Hiroyuki Ono: Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Sasaki T, Uesato M, Ohta T. et al. Gastric endoscopic submucosal dissection via gastrostoma before the second operation for esophageal perforation: A case report. World J Gastrointest Endosc 2018; 10: 121-124
• 2 Shichijo S, Kawakami Y, Higashino K. et al. Retrograde esophageal endoscopic submucosal dissection through a gastrostomy. Endoscopy 2023; 55: E507-E508
• 3 Miura Y, Fukuda H, Ueno T. et al. Endoscopic submucosal dissection of gastric neoplasms with severe fibrosis using a new thin-therapeutic endoscope and a dedicated conical cap. Endoscopy 2023; 55: E872-E873
• 4 Hashimoto K, Fukuda H, Fujinuma T. et al. Combination of the saline-immersion technique and a new thin therapeutic endoscope for endoscopic submucosal dissection of a duodenal subepithelial tumor. Endoscopy 2025; 57: E3-E4
• 5 Miyazaki K, Kato M, Kanai T. et al. Esophageal endoscopic submucosal dissection using a novel thin therapeutic scope for early esophageal cancer adjacent to chemoradiotherapy-induced stricture. Endoscopy 2023; 55: E581-E582

Publication History

Article published online:
19 November 2025