Journal List > Korean J Gastroenterol > v.71(3) > 1007740

Min: Endoscopic Treatment for Esophageal Cancer

Abstract

Esophageal cancer incidence rate per 100,000 is 4.7 in 2013, which accounts for 1.1% of the total cancer incidence in Korea. Superficial esophageal squamous cell carcinoma is frequently detected in persons undergoing upper endoscopy for gastrointestinal symptoms or for gastric cancer screening. Esophagectomy with lymph node dissection is the standard treatment for esophageal cancer. However, given the considerable morbidity and mortality of esophagectomy, endoscopic resection has become the standard of care for most cases of superficial esophageal squamous cell carcinoma without metastasis. In addition, endoscopic submucosal dissection has increased the cure rate, even when the tumor is large, compared to endoscopic mucosal resection. Thus, endoscopic submucosal dissection is the treatment of choice for superficial esophageal squamous cell carcinoma with a negligible risk of lymph node metastasis. Endoscopic resection is usually associated with a low risk of morbidity and no mortality, and has also shown favorable long-term outcomes. However, the long-term risk of metastasis remains after endoscopic resection, which varies according to the characteristics of tumor. This review describes the indication and outcomes of endoscopic resection, complications of endoscopic resection, and management after treatment.

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Fig. 1.
Endoscopic submucosal dissection procedure. (A) On the lower thoracic esophagus, a 3-cm-sized geographic mucosal hyperemia with uneven surface is noticed. (B) Lugol's solution is sprayed along the lesion to aid visualization. (C) Marking around the lesion is performed. (D) After submucosal injection, circumferential mucosal pre-cutting is performed. (E) After dissection of the submucosal layer, an artificial ulcer is seen. (F) Fixation of the resected specimen.
kjg-71-116f1.tif
Table 1.
Outcomes of Endoscopic Submucosal Dissection for SEN
  Patients (n) Indication FU period (mo) EnR (%) CR (%) CuR (%) 5-year OS (%) 5-year DSS (%) Stricture (%) Perforation (%)
Ono et al. (2009)47 84 SEN 21 100 88.0 NA 95/56 a 100/85 a 17.9 4.0
Takahashi et al. (2010)9 116 SESCC 65 100 NA 97.0 NA NA 17.2 2.6
Tsujii et al. (2015)42 312 SEN 35 96.7 84.5 76.2 NA 84.8/72.7 b 7.1 5.2
Joo et al. (2014)45 27 SESCC 23 93.0 83.0 NA 84.0 100 7.0 7.0
Park et al. (2016)43 225 SEN 35 93.9 89.7 77.0 89.7 100 6.5 4.6
Park et al. (2016)46 36 SEN 31 97.2 91.7 NA NA NA 13.9 5.6

SEN, superficial esophageal neoplasms; FU, follow-up; EnR, en bloc resection; CR, complete resection; CuR, curative resection; OS, overall survival; DSS, disease specific survival; NA, not available; SESCC, superficial esophageal squamous cell carcinoma.

a M1 and M2 cancer/M3 and SM cancers; b CuR/non-CuR.

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