Post-endoscopy esophageal squamous cell carcinoma invading into muscularis mucosa or submucosal layer: a case series

This study aimed to identify the clinicopathological features of esophageal squamous cell carcinoma (ESCC), detected at the stage of T1a-MM or deeper despite undergoing annual endoscopic surveillance. This retrospective study included cases of early ESCC treated with endoscopic resection at this hospital from January 2015 to October 2024. Inclusion criteria were: (i) A case identified as a high-risk patient for ESCC due to the presence of multiple Lugol-voiding lesions . (ii) Screening endoscopy performed at intervals of 12 months or less. (iii) The depth of lesions detected under appropriate screening and treated with endoscopic resection was pT1a-MM or deeper. Five cases met the criteria, with a median age of 68 years (range: 48-81); all patients were male. The prior endoscopic examination before the detection was performed 6 months earlier in two cases and 12 months earlier in three cases. Among the cases, three lesions were located in the cervical esophagus (Ce), one in the middle thoracic esophagus (Mt), and one in the lower thoracic esophagus (Lt); the Mt and Lt lesions were on the anterior wall. The three Ce lesions measured 5-10 mm, while the Mt and Lt lesions measured 6 mm and 10 mm, respectively. Four lesions were diagnosed as pT1a-MM, and the Ce lesion as pT1b-SM2 with positive vascular invasion. The patient diagnosed with submucosa lesion received additional chemoradiotherapy. None of the patients have experienced cancer recurrence. This case series suggests that the Ce and the anterior wall of the Mt and Lt may be areas that require particular attention during routine ESCC surveillance. These findings may help improve quality of surveillance endoscopy for ESCC high-risk patients.