Treatment of Circumferential Squamous Cell Carcinoma of the Esophagus by Endoscopic Submucosal Dissection

Abstract

OBJECTIVE The aim of this study is to demonstrate the effectiveness and safety of endoscopic submucosal dissection (ESD) in the treatment of circumferential squamous cell carcinoma (SCC). It investigates the feasibility of an endoscopic approach in cases of circumferential SCC in the distal esophagus without the need for surgical intervention. METHODS Endoscopic submucosal dissection is used as a treatment method for early stage esophageal cancers. In this technique, the submucosal tissue surrounding the lesion is carefully dissected, and the tumor is removed en bloc. During the procedure, the “clip and line” traction method aids in the smooth lifting of the mucosa and facilitates proper tensioning of the operative area. Written informed consent was obtained from patients who participated in this study RESULTS A 62-year-old female patient presented to our clinic with a 1-year history of progressively worsening dysphagia. Esophagogastroduodenoscopy (EGD) revealed thickening of the mucosal layer surrounding the lumen in the distal esophagus and a B3 vascular pattern according to the Japanese Endoscopy Society classification. Chromoendoscopy using 1% Lugol’s solution to examine suspected SCC showed circumferential involvement in a 10 cm segment. No pathological lymph nodes were observed on endoscopic ultrasound, and the muscularis propria layer remained intact. The area, initially thought to be superficial SCC, was resected en bloc using the endoscopic submucosal dissection method through 2 tunnels in 156 minutes. The “clip and line” traction method was employed during the procedure. The histological diagnosis was SCC-T1b. Although surgical margins were intact, deep submucosal invasion (>200 microns) and lymphovascular invasion were observed. Therefore, adjuvant chemoradiotherapy was planned. The patient returned to our clinic in the first postoperative month due to dysphagia, and a narrowing of the ESD scar was noted during the control EGD examination. A covered metallic esophageal stent was placed. CONCLUSION Endoscopic submucosal dissection proves to be an effective and safe method in the treatment of early-stage circumferential SCC.