Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic resection is a primary treatment for non-invasive esophageal squamous cell neoplasms (ESCNs).
• Endoscopic mucosal resection (EMR) is effective for small lesions but limited by piecemeal resection for larger ones, leading to recurrence.
• Endoscopic submucosal dissection (ESD) enables en bloc resection of esophageal lesions, regardless of size, with lower recurrence rates.

Purpose of the Study:

• To review the efficacy and safety of endoscopic submucosal dissection (ESD) for esophageal squamous cell neoplasms (ESCNs).
• To compare ESD with endoscopic mucosal resection (EMR) and traditional surgery.
• To discuss emerging strategies for managing complications and potential combination therapies involving ESD.

Main Methods:

• Review of current literature on endoscopic resection techniques for ESCNs.
• Comparison of outcomes between EMR and ESD, including resection size, histological evaluation, and recurrence rates.
• Analysis of complications associated with ESD, such as esophageal stricture, and their management.

Main Results:

• ESD allows for en bloc resection of ESCNs, improving histological evaluation and reducing local recurrence compared to EMR.
• While ESD has a lower complication rate than expected, esophageal stricture remains a concern for large resections.
• Oral prednisolone and combination therapy (chemoradiotherapy and ESD) show promise for stricture prevention and treating advanced lesions.

Conclusions:

• ESD is a crucial technique for treating superficial esophageal squamous cell neoplasms, offering advantages over EMR.
• Ongoing research focuses on optimizing ESD strategies and managing post-procedural complications like strictures.
• ESD, potentially combined with other therapies, is poised to be a central treatment modality for ESCNs.