Endoscopic Treatment for Esophageal Cancer

Yang Won Min

doi:10.4166/kjg.2018.71.3.116

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Min: Endoscopic Treatment for Esophageal Cancer

Review Article

Korean J Gastroenterol 2018;71(3):116-123.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.3.116

Endoscopic Treatment for Esophageal Cancer

Yang Won Min

Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Yang Won Min, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail: yangwonee@gmail.com

Received 19 February 2018 Accepted 15 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Endoscopic mucosal resection, Endoscopic submucosal dissection, Esophageal squamous cell carcinoma

References

1. Lee KS, Oh DK, Han MA, et al. Gastric cancer screening in Korea: report on the national cancer screening program in 2008. Cancer Res Treat. 2011; 43:83–88.

2. Shimizu Y, Takahashi M, Yoshida T, et al. Endoscopic resection (endoscopic mucosal resection/endoscopic submucosal abdominal) for superficial esophageal squamous cell carcinoma: current status of various techniques. Dig Endosc. 2013; 25(Suppl 1):13–19.

3. Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endo-cytoscopy system. Endoscopy. 2004; 36:590–594.

4. Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo SE. Narrow-band imaging system with magnifying endoscopy for abdominal esophageal lesions. Gastrointest Endosc. 2004; 59:288–295.

5. Tachibana M, Hirahara N, Kinugasa S, Yoshimura H. Clinicopathologic features of superficial esophageal cancer: results of consecutive 100 patients. Ann Surg Oncol. 2008; 15:104–116.

6. Ra J, Paulson EC, Kucharczuk J, et al. Postoperative mortality abdominal esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol. 2008; 15:1577–1584.

7. Chang AC, Ji H, Birkmeyer NJ, Orringer MB, Birkmeyer JD. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg. 2008; 85:424–429.

8. Connors RC, Reuben BC, Neumayer LA, Bull DA. Comparing abdominals after transthoracic and transhiatal esophagectomy: a 5-year prospective cohort of 17,395 patients. J Am Coll Surg. 2007; 205:735–740.

9. 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. 264.e1–2.

10. Eguchi T, Nakanishi Y, Shimoda T, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006; 19:475–480.

11. Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a abdominal analysis of 295 patients. Ann Surg. 2013; 257:1032–1038.

12. Choi JY, Park YS, Jung HY, et al. Feasibility of endoscopic resection in superficial esophageal squamous carcinoma. Gastrointest Endosc. 2011; 73:881–889. 889.e1-e2.

13. Endoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005; 37:570–578.

14. Pyo JH, Byeon SJ, Lee H, et al. Measurement of tumor volume is not superior to diameter for prediction of lymph node metastasis in early gastric cancer with minute submucosal invasion. Oncotarget. 2017; 8:113758–113765.

15. Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of abdominal esophageal cancers: a systematic review and metaanalysis. Gastrointest Endosc. 2012; 75:242–253.

16. Lee WC, Lee TH, Jang JY, et al. Staging accuracy of endoscopic ultrasound performed by nonexpert endosonographers in abdominals with resectable esophageal squamous cell carcinoma: is it possible? Dis Esophagus. 2015; 28:574–578.

17. Dhupar R, Rice RD, Correa AM, et al. Endoscopic ultrasound abdominal for tumor depth at the gastroesophageal junction are inaccurate: implications for the liberal use of endoscopic resection. Ann Thorac Surg. 2015; 100:1812–1816.

18. Oyama T, Inoue H, Arima M, et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus. 2017; 14:105–112.

19. Ebi M, Shimura T, Yamada T, et al. Multicenter, prospective trial of white-light imaging alone versus white-light imaging followed by magnifying endoscopy with narrow-band imaging for the re-al-time imaging and diagnosis of invasion depth in superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2015; 81:1355–1361.e2.

20. Mizumoto T, Hiyama T, Oka S, et al. Diagnosis of superficial esophageal squamous cell carcinoma invasion depth before abdominal submucosal dissection. Dis Esophagus. 2017; Dec 18:[Epub ahead of print].

21. Rice TW. Superficial oesophageal carcinoma: is there a need for three-field lymphadenectomy? Lancet. 1999; 354:792–794.

22. Akutsu Y, Kato K, Igaki H, et al. The prevalence of overall and abdominal lymph node metastases in clinical T1N0 thoracic esophageal cancer: from the results of JCOG0502, a prospective multicenter study. Ann Surg. 2016; 264:1009–1015.

23. Li B, Chen H, Xiang J, et al. Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2013; 146:1198–1203.

24. Pech O, May A, Günter E, Gossner L, Ell C. The impact of abdominal ultrasound and computed tomography on the TNM abdominal of early cancer in Barrett's esophagus. Am J Gastroenterol. 2006; 101:2223–2229.

25. Kato H, Kuwano H, Nakajima M, et al. Comparison between abdominal emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002; 94:921–928.

26. Yoon YC, Lee KS, Shim YM, Kim BT, Kim K, Kim TS. Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection abdominal study. Radiology. 2003; 227:764–770.

27. Murata Y, Ohta M, Hayashi K, Ide H, Takasaki K. Preoperative evaluation of lymph node metastasis in esophageal cancer. Ann Thorac Cardiovasc Surg. 2003; 9:88–92.

28. Kim K, Park SJ, Kim BT, Lee KS, Shim YM. Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography. Ann Thorac Surg. 2001; 71:290–294.

29. Choi JY, Lee KH, Shim YM, et al. Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET. J Nucl Med. 2000; 41:808–815.

30. Ishihara R, Iishi H, Uedo N, et al. Comparison of EMR and abdominal submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc. 2008; 68:1066–1072.

31. Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal abdominal for tumors of the gastrointestinal tract. Endoscopy. 2009; 41:751–757.

32. Kim DH, Jung HY, Gong EJ, et al. Endoscopic and oncologic abdominals of endoscopic resection for superficial esophageal neoplasm. Gut Liver. 2015; 9:470–477.

33. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015; 47:829–854.

34. Japan Esophageal Society. Japanese classification of abdominal cancer, 11th edition: part I. Esophagus. 2017; 14:1–36.

35. Higuchi K, Tanabe S, Koizumi W, et al. Expansion of the abdominal for endoscopic mucosal resection in patients with abdominal esophageal carcinoma. Endoscopy. 2007; 39:36–40.

36. Ajani JA, D'Amico TA, Almhanna K, et al. Esophageal and abdominal junction cancers, version 1.2015. J Natl Compr Canc Netw. 2015; 13:194–227.

37. Kim DU, Lee JH, Min BH, et al. Risk factors of lymph node abdominal in T1 esophageal squamous cell carcinoma. J Gastroenterol Hepatol. 2008; 23:619–625.

38. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal abdominal of early esophageal cancer. Clin Gastroenterol Hepatol. 2005; 3(7 Suppl 1):S67–S70.

39. Moriya H, Ohbu M, Kobayashi N, et al. Lymphatic tumor emboli detected by D2–40 immunostaining can more accurately predict abdominal metastasis. World J Surg. 2011; 35:2031–2037.

40. Katada C, Muto M, Momma K, et al. Clinical outcome after abdominal mucosal resection for esophageal squamous cell abdominal invading the muscularis mucosae–a multicenter abdominal cohort study. Endoscopy. 2007; 39:779–783.

41. Yamashina T, Ishihara R, Nagai K, et al. abdominal outcome and metastatic risk after endoscopic resection of superficial abdominal squamous cell carcinoma. Am J Gastroenterol. 2013; 108:544–551.

42. Tsujii Y, Nishida T, Nishiyama O, et al. Clinical outcomes of abdominal submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy. 2015; 47:775–783.

43. Park HC, Kim DH, Gong EJ, et al. Ten-year experience of abdominal endoscopic submucosal dissection of superficial abdominal neoplasms in a single center. Korean J Intern Med. 2016; 31:1064–1072.

44. Probst A, Aust D, Märkl B, Anthuber M, Messmann H. Early abdominal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy. 2015; 47:113–121.

45. Joo DC, Kim GH, Park DY, Jhi JH, Song GA. abdominal outcome abdominal endoscopic submucosal dissection in patients with abdominal esophageal squamous cell carcinoma: a single-center study. Gut Liver. 2014; 8:612–618.

46. Park JS, Youn YH, Park JJ, Kim JH, Park H. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc. 2016; 49:168–175.

47. Ono S, Fujishiro M, Niimi K, et al. abdominal outcomes of abdominal submucosal dissection for superficial esophageal abdominal cell neoplasms. Gastrointest Endosc. 2009; 70:860–866.

48. Kim GH, Jee SR, Jang JY, et al. Stricture occurring after abdominal submucosal dissection for esophageal and gastric tumors. Clin Endosc. 2014; 47:516–522.

49. Song BG, Min YW, Lee JH, et al. Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal abdominal cell carcinoma. Surg Endosc. 2017; 31:3905–3911.

50. Yamashita K, Shiwaku H, Ohmiya T, et al. Efficacy and safety of endoscopic submucosal dissection under general anesthesia. World J Gastrointest Endosc. 2016; 8:466–471.

51. Jain D, Singhal S. Esophageal stricture prevention after abdominal submucosal dissection. Clin Endosc. 2016; 49:241–256.

52. Shi Q, Ju H, Yao LQ, et al. Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial abdominal carcinoma. Endoscopy. 2014; 46:640–644.

53. Kataoka M, Anzai S, Shirasaki T, et al. Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer. Endosc Int Open. 2015; 3:E113–E117.

54. Wang W, Ma Z. Steroid administration is effective to prevent abdominals after endoscopic esophageal submucosal dissection: a network metaanalysis. Medicine (Baltimore). 2015; 94:e1664.

55. Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic abdominal dissection. Gastrointest Endosc. 2011; 74:1389–1393.

56. Okamoto K, Matsui S, Watanabe T, et al. Clinical analysis of esophageal stricture in patients treated with intralesional abdominal injection after endoscopic submucosal dissection for superficial esophageal cancer. Oncology. 2017; 93(Suppl 1):9–14.

57. Yamasaki T, Tomita T, Takimoto M, et al. Esophageal stricture abdominal endoscopic submucosal dissection treated successfully by temporary stent placement. Clin J Gastroenterol. 2016; 9:337–340.

58. Lian JJ, Ma LL, Hu JW, et al. Endoscopic balloon dilatation for abdominal esophageal stricture after endoscopic submucosal abdominal for early esophageal neoplasms. J Dig Dis. 2014; 15:224–229.

59. Ohki T, Yamato M, Ota M, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-en-gineered cell sheets. Gastroenterology. 2012; 143:582–588.e2.

60. Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M. Polyglycolic acid sheet application to prevent esophageal abdominal after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy. 2015; 47:341–344.

61. Yamaguchi N, Isomoto H, Kobayashi S, et al. Oral epithelial cell sheets engraftment for esophageal strictures after endoscopic submucosal dissection of squamous cell carcinoma and air-plane transportation. Sci Rep. 2017; 7:17460.

62. Kudou M, Shiozaki A, Fujiwara H, et al. Efficacy of additional abdominal resection after endoscopic submucosal dissection for abdominal esophageal cancer. Anticancer Res. 2017; 37:5301–5307.

63. Nemoto K, Yamada S, Nishio M, et al. Results of radiation therapy for superficial esophageal cancer using the standard abdominal method recommended by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group. Anticancer Res. 2006; 26(2B):1507–1512.

64. Motoori M, Yano M, Ishihara R, et al. Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer. Ann Surg Oncol. 2012; 19:2135–2141.

65. Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of abdominal submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol. 2015; 10:31.

66. Ikeda A, Hoshi N, Yoshizaki T, et al. Endoscopic submucosal abdominal (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med. 2015; 54:2803–2813.

67. Hamada K, Ishihara R, Yamasaki Y, et al. Efficacy and safety of endoscopic resection followed by chemoradiotherapy for abdominal esophageal squamous cell carcinoma: a retrospective study. Clin Transl Gastroenterol. 2017; 8:e110.

68. Kurokawa Y, Muto M, Minashi K, Boku N, Fukuda H. Gastrointestinal Oncology Study Group of Japan Clinical Oncology Group (JCOG). A phase II trial of combined treatment of endoscopic abdominal resection and chemoradiotherapy for clinical stage I esophageal carcinoma: Japan Clinical Oncology Group Study JCOG0508. Jpn J Clin Oncol. 2009; 39:686–689.

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.

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.

TOOLS

Similar articles