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Effectiveness and safety of endoscopic aspiration mucosectomy and endoscopic submucosal dissection in patients with superficial esophageal squamous-cell carcinoma

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Abstract

Background

Endoscopic submucosal dissection (ESD) has been performed in a high proportion of patients with superficial esophageal squamous-cell carcinoma. Endoscopic aspiration mucosectomy (EAM) is a more straightforward technique that is easier to perform. We retrospectively evaluated the safety and efficacy of EAM and ESD to clarify the advantages and disadvantages of each procedure.

Methods

A total of 374 patients (423 lesions) who underwent endoscopic resection were retrospectively studied. The following variables were evaluated (1) procedure time and adverse events as safety, and (2) en bloc complete resection rate, local recurrence rate, lymph node recurrence rate, overall survival rate, and cause-specific survival rate as efficacy.

Results

EAM was performed in 134 patients (149 lesions), and ESD was performed in 240 patients (274 lesions). The procedure times of EAM and ESD were 31.0 ± 22.4 and 85.7 ± 46.5 min (p < 0.001), respectively. The perforation rates were 0 and 6.2% (p = 0.002), respectively. The en bloc complete resection rates were 48.3 and 91.6% (p < 0.001), respectively. The local recurrence rates were 5.5 and 0% (p < 0.001), respectively. For lesions measuring less than 15 mm in diameter, EAM had a relatively good en bloc complete resection rate (EAM, 76.1% vs. ESD, 100%) and a significantly short procedure time (EAM, 25.2 ± 15.2 min vs. ESD, 62.7 ± 35.2 min; p < 0.001).

Conclusions

ESD has a higher en bloc complete resection rate and a better local control rate than EAM. For lesions measuring less than 15 mm in diameter, EAM may be a treatment option.

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Authors and Affiliations

  1. Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yasuaki Furue, Chikatoshi Katada, Kenji Ishido, Yuki Kondo, Yo Kubota, Natuko Kawanishi, Sakiko Yamane, Akinori Watanabe, Takuya Wada, Takafumi Yano, Mizutomo Azuma & Wasaburo Koizumi

  2. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

    Yasuaki Furue

  3. Research and Development Center for New Frontier, Kitasato University School of Medicine, Sagamihara, Japan

    Satoshi Tanabe

  4. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Hiromitsu Moriya & Keishi Yamashita

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  1. Yasuaki Furue
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  2. Chikatoshi Katada
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  14. Mizutomo Azuma
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  15. Wasaburo Koizumi
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Correspondence to Chikatoshi Katada.

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Yasuaki Furue, Chikatoshi Katada, Satoshi Tanabe, Kenji Ishido, Yuki Kondo, Yo Kubota, Natuko Kawanishi, Sakiko Yamane, Akinori Watanabe, Hiromitsu Moriya, Keishi Yamashita, Takuya Wada, Takafumi Yano, Mizutomo Azuma, and Wasaburo Koizumi have no conflicts of interest or financial ties to disclose.

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Furue, Y., Katada, C., Tanabe, S. et al. Effectiveness and safety of endoscopic aspiration mucosectomy and endoscopic submucosal dissection in patients with superficial esophageal squamous-cell carcinoma. Surg Endosc 33, 1433–1440 (2019). https://doi.org/10.1007/s00464-018-6418-3

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  • DOI: https://doi.org/10.1007/s00464-018-6418-3

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