Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection

 

 Buy Article Permissions and Reprints

Background and study aims: Endoscopic resection is the standard treatment for superficial esophageal cancer. Data on early adenocarcinoma (EAC) are widely restricted to endoscopic mucosal resection (EMR), whereas large studies have been published on endoscopic submucosal dissection (ESD) for early squamous cell carcinoma (ESCC). ESD has potential advantages regarding en bloc and R0 resection rates, which have been demonstrated for ESCC. However, studies have failed to confirm these advantages in EAC. The aim of this study was to investigate the efficacy of ESD in early esophageal cancer.

Patients and methods: A total of 111 early esophageal cancers (87 EACs and 24 ESCCs) were resected by ESD at a German tertiary referral center. A total of 60 EACs were resected within Barrett’s segments ≤ M3. Resection rates, complications, and follow-up data were recorded prospectively.

Results: En bloc resection rates were 95.4 % for EAC and 100 % for ESCC (P = 0.575), and R0 resection rates were 83.9 % and 91.7 %, respectively (P = 0.515). The R0 resection rate was higher in Barrett’s ≤ M3 vs. > M3 (90 % vs. 70.4 %; P = 0.029). The curative resection rate was 72.4 % for EAC vs. 45.8 % for ESCC (P = 0.026). Endoluminal recurrence was observed in 2.4 % of EACs (8 % in Barrett’s > M3, 0 % in Barrett’s ≤ M3), and 0 % of ESCCs. Complications included strictures (11.7 %) and bleedings (0.9 %), but no perforation. Disease-specific survival was 97.7 % (EAC) and 95.8 % (ESCC), and overall survival was 96.6 % (EAC) and 66.7 % (ESCC) over a mean follow-up period of 24.3 months and 38.0 months, respectively.

Conclusions: ESD was shown to be a safe resection method, achieving high R0 resection rates in both EAC and ESCC. Recurrence rates were low. To improve R0 resection within long Barrett’s segments, diagnosis of the lateral extension of the lesion needs to be improved.

• References

• 1 Dubecz A, Solymosi N, Stadlhuber RJ et al. Does the incidence of adenocarcinoma of the esophagus and the gastric cardia continue to rise in the twenty-first century? – A SEER database analysis. J Gastrointest Surg 2014; 18: 124-129
  CrossrefPubMedSearch in Google Scholar
• 2 Bosetti C, Levi F, Ferlay J et al. Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer 2008; 122: 1118-1129
  PubMedSearch in Google Scholar
• 3 Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastrenterol Hepatol 2009; 24: 729-735
  PubMedSearch in Google Scholar
• 4 Ell C, May A, Pech O et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 2007; 65: 3-10
  CrossrefPubMedSearch in Google Scholar
• 5 Takahashi H, Arimura Y, Masao H et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
  CrossrefPubMedSearch in Google Scholar
• 6 Pech O, Behrens A, May A et al. Long term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s esophagus. Gut 2008; 57: 1200-1206
  CrossrefPubMedSearch in Google Scholar
• 7 Miyamoto S, Muto M, Hamamoto Y et al. A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 2002; 55: 576-581
  CrossrefPubMedSearch in Google Scholar
• 8 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European Center. Endoscopy 2010; 42: 1037-1044
  Thieme ConnectPubMedSearch in Google Scholar
• 9 Repici H, Hassan C, Carlino A et al. Endoscopic submucoal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 2010; 71: 715-721
  CrossrefPubMedSearch in Google Scholar
• 10 Neuhaus H, Terheggen G, Rutz EM et al. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy 2012; 44: 1105-1113
  Thieme ConnectPubMedSearch in Google Scholar
• 11 Sharma P, Dent J, Armstrong D et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
  CrossrefPubMedSearch in Google Scholar
• 12 Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
  Thieme ConnectPubMedSearch in Google Scholar
• 13 Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
  Search in Google Scholar
• 14 Koop H, Schepp W, Müller-Lissner S et al. Consensus Conference of the DGVS on Gastroesophageal Reflux. Z Gastroenterol 2005; 43: 163-164
  Thieme ConnectPubMedSearch in Google Scholar
• 15 Bennett C, Vakil N, Bergman J et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143: 336-346
  CrossrefPubMedSearch in Google Scholar
• 16 Eguchi T, Nakanishi Y, Shimoda T et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol 2006; 19: 475-480
  CrossrefPubMedSearch in Google Scholar
• 17 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-70
  CrossrefPubMedSearch in Google Scholar
• 18 Pech O, May A, Manner H et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660
  CrossrefPubMedSearch in Google Scholar
• 19 Ishihara R, Iishi H, Takauchi Y et al. Local recurrence of large squamous-cell carcinoma of the esophagus after resection. Gastrointest Endosc 2008; 67: 799-804
  CrossrefPubMedSearch in Google Scholar
• 20 Takahashi H, Arimura Y, Masao H et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
  CrossrefPubMedSearch in Google Scholar
• 21 Kagemoto K, Oka S, Tanaka S et al. Clinical outcomes of endoscopic submucosal dissection for superficial Barrett’s adenocarcinoma. Gastrointest Endosc 2014; 80: 239-245
  CrossrefPubMedSearch in Google Scholar
• 22 Probst A, Golger D, Arnholdt A et al. Endoscopic submucosal dissection of early cancers, flat adenomas and submucosal tumors in the gastrointestinal tract. Clin Gastroenterol Hepatol 2009; 7: 149-155
  CrossrefPubMedSearch in Google Scholar
• 23 Probst A, Golger D, Anthuber M et al. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European Center. Endoscopy 2012; 44: 660-667
  Thieme ConnectPubMedSearch in Google Scholar
• 24 Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc 2012; 16: 162-166
  PubMedSearch in Google Scholar