Surgical Endoscopy

, Volume 32, Issue 6, pp 2814–2821 | Cite as

Endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for large superficial esophageal squamous cell neoplasm: efficacy and safety study to guide future practice

  • Wengang Zhang
  • Yaqi Zhai
  • Ningli Chai
  • Enqiang Linghu
  • Zhongsheng Lu
  • Huikai Li
  • Xiuxue Feng
Article

Abstract

Background and study aims

ESTD and ESD are currently the two primary treatment options for superficial esophageal squamous cell neoplasm (SESCN) in China. However, in larger cases, ESD proves to be technically challenging and time saving, whereas ESTD exhibits promising efficacy. This study aims to evaluate the efficacy and safety of these two techniques for large SESCN.

Patients and methods

A total of 150 patients with solitary large SESCN that underwent either ESTD (n = 52) or ESD (n = 98) between August 2011 and June 2016 were included in this study. Both efficacy and safety clinical data were collected and analyzed.

Results

All of the 150 patients were found to successfully undergo ESTD or ESD with 92.68 ± 67.96 (mean ± SD) min. The specimen area was measured to be 13.79 ± 7.44 (mean ± SD) cm2 and the dissection speed was 17.99 ± 10.40 (mean ± SD) mm2/min. En bloc resection and R0 resection were achieved in 91.33% (137/150) and 86.00% (129/150) of the cases, respectively. A total of 8.67% (13/150) were found to have intra-operative adverse events. Based on statistical analysis, ESTD was found to have a higher dissection speed and a similar adverse event rate compared with ESD. Moreover, a long operation time was found to be an independent risk factor for intra-operative adverse events.

Conclusions

ESTD and ESD both were found to be effective and safe treatment options for the treatment of large SESCN. ESTD appeared to improve operation efficacy, which was reflected in a higher dissection speed compared with ESD. We also demonstrate that long operation times should be avoided as much as possible in order to reduce intra-operative adverse events.

Keywords

Endoscopic submucosal tunnel dissection Endoscopic submucosal dissection Superficial esophageal squamous cell neoplasm 

Notes

Funding

The present study was supported by grants from the National Key R&D Program of China (Grant No. 2016YFC1303601).

Compliance with ethical standards

Disclosures

Drs. Wengang Zhang, Yaqi Zhai, Ningli Chai, Enqiang Linghu, Zhongsheng Lu, Huikai Li, and Xiuxue Feng have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108CrossRefPubMedGoogle Scholar
  2. 2.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefPubMedGoogle Scholar
  3. 3.
    Lu XJ, Chen ZF, Guo CL, Li SS, Bai WL, Jin GL, Wang YX, Meng FS, Gao F, Hou J (2004) Endoscopic survey of esophageal cancer in a high-risk area of China. World J Gastroenterol 10:2931–2935CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Pech O, Gossner L, May A, Vieth M, Stolte M, Ell C (2004) Endoscopic resection of superficial esophageal squamous-cell carcinomas: Western experience. Am J Gastroenterol 99:1226–1232CrossRefPubMedGoogle Scholar
  5. 5.
    Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoleon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T (2007) Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 39:24–29CrossRefPubMedGoogle Scholar
  6. 6.
    Zhang YM, Boerwinkel DF, He S, Weusten BL, Xue LY, Fleischer DE, Lu N, Dawsey SM, Zuo SM, Qin XM, Dou LZ, Bergman JJ, Wang GQ (2013) Prospective feasibility study on the use of multiband mucosectomy for endoscopic resection of early squamous neoplasia in the esophagus. Endoscopy 45:167–173CrossRefPubMedGoogle Scholar
  7. 7.
    Zhang YM, Boerwinkel DF, Qin X, He S, Xue L, Weusten BL, Dawsey SM, Fleischer DE, Dou LZ, Liu Y, Lu N, Bergman JJ, Wang GQ (2016) A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus. Endoscopy 48:330–338CrossRefPubMedGoogle Scholar
  8. 8.
    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 71:715–721CrossRefPubMedGoogle Scholar
  9. 9.
    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 70:860–866CrossRefPubMedGoogle Scholar
  10. 10.
    Fernandez-Esparrach G, Calderon A, de la Pena J, Diaz Tasende JB, Esteban JM, Gimeno-Garcia AZ, Herreros de Tejada A, Martinez-Ares D, Nicolas-Perez D, Nogales O, Ono A, Orive-Calzada A, Parra-Blanco A, Rodriguez Munoz S, Sanchez Hernandez E, Sanchez-Yague A, Vazquez-Sequeiros E, Vila J, Lopez Roses L (2014) Endoscopic submucosal dissection. Endoscopy 46:361–370CrossRefPubMedGoogle Scholar
  11. 11.
    Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y (2015) Indications and techniques for endoscopic submucosal dissection. Am J Gastroenterol 110:784–791CrossRefPubMedGoogle Scholar
  12. 12.
    Maple JT, Abu Dayyeh BK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Konda V, Murad FM, Siddiqui UD, Banerjee S (2015) Endoscopic submucosal dissection. Gastrointest Endosc 81:1311–1325CrossRefPubMedGoogle Scholar
  13. 13.
    Linghu E, Feng X, Wang X, Meng J, Du H, Wang H (2013) Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy 45:60–62PubMedGoogle Scholar
  14. 14.
    Zhai YQ, Li HK, Linghu EQ (2016) Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms. World J Gastroenterol 22:435–445CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Arantes V, Albuquerque W, Freitas Dias CA, Demas Alvares Cabral MM, Yamamoto H (2013) Standardized endoscopic submucosal tunnel dissection for management of early esophageal tumors (with video). Gastrointest Endosc 78:946–952CrossRefPubMedGoogle Scholar
  16. 16.
    Pioche M, Mais L, Guillaud O, Hervieu V, Saurin JC, Ponchon T, Lepilliez V (2013) Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy 45:1032–1034CrossRefPubMedGoogle Scholar
  17. 17.
    Huang R, Cai H, Zhao X, Lu X, Liu M, Lv W, Liu Z, Wu K, Han Y (2017) Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis. Gastrointest Endosc 86:831–838CrossRefPubMedGoogle Scholar
  18. 18.
    Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clinical Gastroenterol Hepatol 3:S67–S70CrossRefGoogle Scholar
  19. 19.
    Zhai Y, Linghu E, Li H (2014) Double-tunnel endoscopic submucosal tunnel dissection for circumferential superficial esophageal neoplasms. Endoscopy 46 Suppl 1 UCTN:E204–E205Google Scholar
  20. 20.
    Park HC, Kim DH, Gong EJ, Na HK, Ahn JY, Lee JH, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH (2016) Ten-year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center. Korean J Intern Med 31:1064–1072CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, Kagaya H, Shimizu Y, Hokari K, Tsukagoshi H, Shinomura Y, Fujita M (2010) 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 72:255–264 264.e251–252Google Scholar
  22. 22.
    Kim DH, Jung HY, Gong EJ, Choi JY, Ahn JY, Kim MY, Choi KS, Lee JH, Choi KD, Song HJ, Lee GH, Kim JH, Park YS, Baek S (2015) Endoscopic and oncologic outcomes of endoscopic resection for superficial esophageal neoplasm. Gut Liver 9:470–477CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of GastroenterologyChinese PLA General HospitalBeijingChina

Personalised recommendations