Pharyngeal endoscopic submucosal dissection: detection, technique, and considerations for Western adoption.

Area of Science:

• Gastroenterology
• Oncology
• Surgical Endoscopy

Background:

• Pharyngeal squamous cell carcinoma (SCC) is increasingly diagnosed at earlier stages, particularly in Japan.
• Endoscopic submucosal dissection (ESD) is a preferred minimally invasive treatment for superficial pharyngeal SCC with excellent outcomes.
• Pharyngeal ESD remains underutilized in Western countries despite rising pharyngeal cancer incidence.

Purpose of the Study:

• To review current evidence on pharyngeal endoscopic submucosal dissection (ESD).
• To discuss indications, techniques, outcomes, and adverse events associated with pharyngeal ESD.
• To identify barriers to pharyngeal ESD adoption in Western practice and propose solutions.

Main Methods:

• Systematic review of contemporary series on pharyngeal ESD.
• Analysis of en bloc and R0 resection rates.
• Evaluation of serious adverse events and unique technical challenges.

Main Results:

• Pharyngeal ESD consistently achieves high en bloc and R0 resection rates.
• Serious adverse events associated with pharyngeal ESD are infrequent.
• Complex anatomy, specialized anesthesia, and exposure techniques present unique challenges.

Conclusions:

• Pharyngeal ESD is a safe and effective treatment for early pharyngeal SCC.
• Barriers to Western adoption include limited knowledge in optical diagnosis.
• Targeted education is proposed to bridge the knowledge gap and increase pharyngeal ESD utilization.