Surgical Endoscopy

, Volume 33, Issue 9, pp 2909–2915 | Cite as

Predictors of technical difficulty during endoscopic submucosal dissection of superficial esophageal cancer

  • Hiromasa Hazama
  • Masaki TanakaEmail author
  • Naomi Kakushima
  • Yohei Yabuuchi
  • Masao Yoshida
  • Noboru Kawata
  • Kohei Takizawa
  • Sayo Ito
  • Kenichiro Imai
  • Kinichi Hotta
  • Hirotoshi Ishiwatari
  • Hiroyuki Matsubayashi
  • Keita Mori
  • Hiroyuki Ono



Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal cancer (SEC); however, it is sometimes technically difficult. Our aim was to identify the predictors of technical difficulty during ESD for SEC.


We reviewed the records of patients who underwent ESD for superficial esophageal squamous cell carcinomas at a tertiary cancer center between April 2008 and March 2016. Patients undergoing ESD after esophagectomy or for residual/recurrent lesions were excluded. Preoperative factors such as tumor subsite, localization, preoperative size, macroscopic type, endoscopic depth of invasion, and treatment for synchronous multiple SECs or previous history of radiation therapy were analyzed. Logistic regression analysis was performed to identify the predictors of technical difficulty, defined as (1) long procedure time (≥ 120 min), (2) adverse events (perforation, pneumomediastinum), or (3) incomplete resection (piecemeal resection, positive or indeterminate vertical margin).


A total of 679 lesions in 511 patients were analyzed. Difficultly was experienced in 60 cases. The procedure time was > 120 min in 43 (6.3%) patients, adverse events occurred in 16 (2.8%), and incomplete resection occurred in 17 (2.5%). Multivariate logistic regression revealed that tumors in the left esophageal wall (OR 2.15; 95% CI 1.17–3.91; p = 0.014) and those encompassing ≥ 1/2 its circumference (OR 5.06; 95% CI 2.40–11.34; p < 0.001) were independently associated with difficulty.


Tumors in the left esophageal wall and tumors measuring > 1/2 of the esophageal circumference are predictors of difficult esophageal ESD. These results may contribute to better patient selection according to each endoscopist’s skill.


Endoscopic submucosal dissection Incomplete resection Technical difficulty Clinical outcomes 



The authors wish to thank the endoscopy staff for their assistance.

Compliance with ethical standards


Drs. Hiromasa Hazama, Masaki Tanaka, Naomi Kakushima, Yohei Yabuuchi, Masao Yoshida, Noboru Kawata, Kohei Takizawa, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Keita Mori, and Hiroyuki Ono have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hiromasa Hazama
    • 1
  • Masaki Tanaka
    • 1
    Email author
  • Naomi Kakushima
    • 1
  • Yohei Yabuuchi
    • 1
  • Masao Yoshida
    • 1
  • Noboru Kawata
    • 1
  • Kohei Takizawa
    • 1
  • Sayo Ito
    • 1
  • Kenichiro Imai
    • 1
  • Kinichi Hotta
    • 1
  • Hirotoshi Ishiwatari
    • 1
  • Hiroyuki Matsubayashi
    • 1
  • Keita Mori
    • 2
  • Hiroyuki Ono
    • 1
  1. 1.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
  2. 2.Clinical Trial Coordination Office, Shizuoka Cancer CenterShizuokaJapan

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