Advertisement

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
Article
  • 213 Downloads

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Endoscopic submucosal dissection Incomplete resection Technical difficulty Clinical outcomes 

Notes

Acknowledgements

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

Compliance with ethical standards

Disclosures

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.

References

  1. 1.
    Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:S67–S70CrossRefGoogle Scholar
  2. 2.
    Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T, Masuda E, Higashino K, Kato M, Narahara H, Tatsuta M (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68:1066–1072CrossRefGoogle Scholar
  3. 3.
    Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70:860–866CrossRefGoogle Scholar
  4. 4.
    Repici A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, Strangio G, Romeo F, Nicita R, Rosati R, Malesci A (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721CrossRefGoogle Scholar
  5. 5.
    Park CH, Kim EH, Kim HY, Roh YH, Lee YC (2015) Clinical outcomes of endoscopic submucosal dissection for early stage esophagogastric junction cancer: a systematic review and meta-analysis. Dig Liver Dis 47:37–44CrossRefGoogle Scholar
  6. 6.
    Isomoto H, Yamaguchi N, Minami H, Nakao K (2013) Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc 25:29–38CrossRefGoogle Scholar
  7. 7.
    Sun F, Yuan P, Chen T, Hu J (2014) Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis. J Cardiothorac Surg 9:78CrossRefGoogle Scholar
  8. 8.
    Sato H, Inoue H, Ikeda H, Grace R, Santi E, Yoshida A, Onimaru M, Kudo S (2014) Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection. Dis Esophagus 27:617–622CrossRefGoogle Scholar
  9. 9.
    Kishida Y, Kakushima N, Kawata N, Tanaka M, Takizawa K, Imai K, Hotta K, Matsubayashi H, Ono H (2015) Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 29:2953–2959CrossRefGoogle Scholar
  10. 10.
    Kawata N, Tanaka M, Kakushima N, Takizawa K, Imai K, Hotta K, Matsubayashi H, Tsukahara M, Kawamura I, Kurai H, Ono H (2016) The low incidence of bacteremia after esophageal endoscopic submucosal dissection (ESD) obviates the need for prophylactic antibiotics in esophageal ESD. Surg Endosc 30:5084–5090CrossRefGoogle Scholar
  11. 11.
    Ono H, Tanaka M, Takizawa K, Kakushima N, Kawata N, Imai K, Hotta K, Matsubayashi H (2015) Utility of the over-the-scope-clip system for treating a large esophageal perforation. Esophagus 12:336–339CrossRefGoogle Scholar
  12. 12.
    Hori K, Uraoka T, Harada K, Higashi R, Kawahara Y, Okada H, Ramberan H, Yahagi N, Yamamoto K (2014) Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy 46:862–870CrossRefGoogle Scholar
  13. 13.
    Imai K, Hotta K, Yamaguchi Y, Kakushima N, Tanaka M, Takizawa K, Kawata N, Matsubayashi H, Shimoda T, Mori K, Ono H (2016) Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 83:954–962CrossRefGoogle Scholar
  14. 14.
    Mizushima T, Kato M, Iwanaga I, Sato F, Kubo K, Ehira N, Uebayashi M, Ono S, Nakagawa M, Mabe K, Shimizu Y, Sakamoto N (2015) Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc 29:133–139CrossRefGoogle Scholar
  15. 15.
    Sato K, Ito S, Kitagawa T, Kato M, Tominaga K, Suzuki T, Maetani I (2014) Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 28:2959–2965CrossRefGoogle Scholar
  16. 16.
    Jang YS, Lee BE, Kim GH, Park DY, Jeon HK, Baek DH, Kim DU, Song GA (2015) Factors associated with outcomes in endoscopic submucosal dissection of gastric cardia tumors: a retrospective observational study. Medicine (Baltimore) 94:e1201CrossRefGoogle Scholar
  17. 17.
    Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H, Takiuchi H, Toh Y, Doki Y, Naomoto Y, Matsubara H, Miyazaki T, Muto M, Yanagisawa A (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 12:1–30CrossRefGoogle Scholar
  18. 18.
    Xie X, Bai JY, Fan CQ, Yang X, Zhao XY, Dong H, Yang SM, Yu J (2017) Application of clip traction in endoscopic submucosal dissection to the treatment of early esophageal carcinoma and precancerous lesions. Surg Endosc 31:462–468CrossRefGoogle Scholar
  19. 19.
    Koike Y, Hirasawa D, Fujita N, Maeda Y, Ohira T, Harada Y, Suzuki K, Yamagata T, Tanaka M (2015) Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial. Dig Endosc 27:303–309CrossRefGoogle Scholar
  20. 20.
    Yoshida M, Takizawa K, Ono H, Igarashi K, Sugimoto S, Kawata N, Tanaka M, Kakushima N, Ito S, Imai K, Hotta K, Matsubayashi H (2016) Efficacy of endoscopic submucosal dissection with dental floss clip traction for gastric epithelial neoplasia: a pilot study (with video). Surg Endosc 30:3100–3106CrossRefGoogle Scholar
  21. 21.
    Japan Esophageal Society (2016) Japanese classification of esophageal cancer, 11th edition: part I Esophagus 14:1–36CrossRefGoogle Scholar
  22. 22.
    Inoue H (2001) Magnification endoscopy in the esophagus and stomach. Dig Endosc 13:40–41CrossRefGoogle Scholar
  23. 23.
    Arima M, Tsunomiya M (2015) Upper G.I. Cancer. I. Diagnosis of magnifying endoscopy for evaluating the invasion depth of superficial esophageal cancer. Gan To Kagaku Ryoho 42:1052–1054Google Scholar
  24. 24.
    Guo HM, Zhang XQ, Chen M, Huang SL, Zou XP (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol 20:5540–5547CrossRefGoogle Scholar
  25. 25.
    Kakushima N, Hori K, Ono H, Horimatsu T, Uedo N, Ohata K, Doyama H, Kaneko K, Oda I, Hikichi T, Kawahara Y, Niimi K, Takaki Y, Mizuno M, Yazumi S, Hosokawa A, Imagawa A, Niimi M, Yoshimura K, Muto M (2016) Proton pump inhibitor after endoscopic resection for esophageal squamous cell cancer: multicenter prospective randomized controlled trial. J Gastroenterol 51:104–111CrossRefGoogle Scholar
  26. 26.
    Imagawa A, Okada H, Kawahara Y, Takenaka R, Kato J, Kawamoto H, Fujiki S, Takata R, Yoshino T, Shiratori Y (2006) Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 38:987–990CrossRefGoogle Scholar
  27. 27.
    Ahn JY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim DH, Song HJ, Lee GH, Jung HY, Kim JH (2011) Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 experts. Gastrointest Endosc 73:911–916CrossRefGoogle Scholar
  28. 28.
    Tsujii Y, Nishida T, Nishiyama O, Yamamoto K, Kawai N, Yamaguchi S, Yamada T, Yoshio T, Kitamura S, Nakamura T, Nishihara A, Ogiyama H, Nakahara M, Komori M, Kato M, Hayashi Y, Shinzaki S, Iijima H, Michida T, Tsujii M, Takehara T (2015) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 47:775–783CrossRefGoogle Scholar
  29. 29.
    Park JS, Youn YH, Park JJ, Kim JH, Park H (2016) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc 49:168–175CrossRefGoogle Scholar
  30. 30.
    Probst A, Aust D, Märkl B, Anthuber M, Messmann H (2015) Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 47:113–121Google Scholar

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

Personalised recommendations