Knife-assisted endoscopic full-thickness resection of deeply invasive esophageal adenocarcinoma: a case series

Esophageal adenocarcinoma (EAC) incidence is rising globally, and current therapeutic options carry substantial morbidity and mortality. We report the feasibility and early outcomes of knife-assisted endoscopic full-thickness resection (kFTR) as a palliative local control in nonsurgical candidates.

Three patients with suspected locally advanced distal EAC (clinical tumor stage T1b-T2), no nodal or distant disease, and high Charlson Comorbidity Index scores were unfit for surgery and declined chemoradiotherapy. All consented to kFTR: a submucosal pocket was created cranial to the suspected invasive area, the muscle-retracting sign was identified, and the muscularis propria was incised to access the periesophageal space. The lesion was dissected laterally and resected en bloc. A fully covered metal stent was then placed.

Patients resumed oral intake on day 5 without major adverse events. All had EAC pathologic tumor stage 1b with invasion into the deepest layer of the submucosa; 2 had positive vertical margins. One remained disease-free (24 months); 2 had local recurrence by 6 months but remained asymptomatic at last follow-up (10 and 14 months).

In carefully selected symptomatic, inoperable patients, kFTR achieved short-to-medium term symptom control for locally advanced EAC with acceptable safety.