Authors D. DE WULF (1), D. DELOOZE (2), P. HINDRYCKX (2), M. DEVOS (2), F. BAERT (1) / [1] AZ Delta, Roeselare, Belgium, gastroenterology, [2] UZ Gent, Gent, Belgium, gastroenterology
Introduction Esophageal endoscopic submucosal dissection (ESD) is a well-defined treatment for early esophageal squamous cell cancer (SCC) in the East. In Europe however most early esophageal cancers arise from Barrett's esophagus (BE) with high grade dysplasia and early adenocarcinoma (AC).
Aim
To assess the efficacy, safety and results of ESD for early esophageal tumors in a European population implementing the ESGE guidelines.
Methods Single operator retrospective cohort study of consecutive patients with an esophageal tumor who underwent ESD between February 2014 and September 2016. A detailed chart review was performed to obtain patient and lesion characteristics, procedural and post-procedural data. Additional treatment after ESD was decided based on the ESGE guidelines. The primary endpoint was the complete (R0) resection rates. Secondary endpoints included the rate of en-bloc resection, procedure related adverse events and recurrence rates at follow-up.
Results 35 patients (29 M, 6 F) with a median age of 63 yrs (range 19-85) underwent ESD for early esophageal cancer (12 SCC, 21 AC and 2 granular cell tumors (GCT) . The median resected specimen size was 43 mm (range 25-75). A curative resection (R0) was achieved in 76,5 % (26/35). 3 patients had a positive deep margin (2 SCC and 1 AC) and 6 had a positive lateral margin (1 SCC and 5 high grade dysplasia in margin in BE). For those 9 patients further treatment options or follow up were multidisciplinary discussed. No deaths nor major adverse events related to the ESD procedure were observed. There was no delayed bleeding. Minor adverse events included a mediastinal collection (n=1), managed conservative with IV antibiotics and esophageal strictures (n=3), all managed endoscopically. One of the strictures developed after adjuvant radiotherapy. According to the ESGE guidelines: 2 patients with R0 resection received adjuvant treatment: 1 surgery for undifferentiated carcinoma; 1 chemoradiotherapy for deep submucosal (more than 200 micron) invasion . After a median follow-up of 15 months (range 2-32) 8 % (2/24) of the R0 treated patients developed a local recurrence (1 SCC - 1 AC) and 8% (2/24) developed a secondary primary tumor in residual BE. All of them were treated with additional surgery, chemo-radiotherapy or both.
Conclusions ESD for early esophageal tumors is a safe and effective treatment with high en-bloc and R0 resection rates and acceptable recurrence rates at follow up. ESGE guidelines are used to guide further treatment after ESD. Long term follow-up is awaited to confirm the feasibility of ESD in the West.
