Enlarging Inflammatory Granulation Tissue After Endoscopic Submucosal Dissection at the Esophageal Inlet During...

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Superficial esophageal squamous cell carcinoma requires precise management.
• Endoscopic submucosal dissection (ESD) is a key technique for early esophageal cancer.
• Post-procedural strictures are a common complication requiring prophylaxis.

Purpose of the Study:

• To report a rare case of exuberant granulation tissue formation after esophageal ESD.
• To describe the diagnostic and therapeutic challenges in the cervical esophagus.
• To emphasize successful endoscopic management and symptom resolution.

Main Methods:

• A 47-year-old woman with prior chemoradiotherapy and esophageal ESD underwent surveillance endoscopy.
• A suspicious lesion at the post-ESD site was managed with repeated endoscopic evaluation and resection.
• Histopathological analysis confirmed granulation tissue, not malignancy.

Main Results:

• A 12-mm superficial squamous cell carcinoma was initially resected via ESD.
• Intensive stricture prophylaxis included triamcinolone injection, oral prednisolone, and balloon dilation.
• A 10-mm lesion developed, initially suspected as neoplastic but confirmed as granulation tissue.
• Complete endoscopic resection resolved symptoms and prevented recurrence during 6-month follow-up.

Conclusions:

• Exuberant granulation tissue can mimic malignancy after esophageal ESD, particularly with intensive stricture prophylaxis.
• Careful endoscopic assessment, including biopsy and resection, is crucial for accurate diagnosis.
• This case demonstrates successful endoscopic management of a rare post-ESD complication, avoiding overtreatment.