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Esophageal ESD

  • Lady Katherine Mejía Pérez
  • Seiichiro Abe
  • Raja Siva
  • John Vargo
  • Amit BhattEmail author
Chapter

Abstract

Esophageal cancer is often diagnosed at later stages. As such, it can be associated with a dismal prognosis. Squamous cell carcinoma (SCC) and esophageal adenocarcinoma (EAC) are its two main histological subtypes. Historically, treatment consisted of radical esophagectomy, which resulted in significant morbidity and mortality. Endoscopic resection emerged as a less invasive alternative for treatment of superficial esophageal cancer and is currently the gold standard. Endoscopic mucosal resection (EMR) was the first endoscopic technique used, with the downside of having higher recurrence rates related to piecemeal resection. Endoscopic submucosal dissection (ESD) was developed in Japan for en bloc removal of early gastric cancer regardless of size, location, and presence of fibrosis. This technique results in accurate evaluation of resection margins, high curative resection rates, and low recurrence rates. ESD has been recognized as the standard treatment for superficial esophageal squamous cell carcinoma (SCC) in Japan and Europe due to its high success rates. However, adoption of ESD in North America, where Barrett’s esophagus-associated adenocarcinoma is the predominant histological subtype, has been slow. Different disease epidemiologies, less exposure to ESD training, reimbursement concerns, and higher complication rates when compared with EMR might contribute to its slower adoption; but now we are seeing wider practice and interest in ESD within the West, as well-trained Western ESD experts are performing high-quality ESD.

Keywords

Endoscopic resection Squamous cell carcinoma High-grade dysplasia (HGD) Barrett’s esophagus En bloc resection Local recurrence Adverse events 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Lady Katherine Mejía Pérez
    • 1
  • Seiichiro Abe
    • 2
  • Raja Siva
    • 3
  • John Vargo
    • 4
  • Amit Bhatt
    • 4
    Email author
  1. 1.Department of Internal MedicineCleveland ClinicClevelandUSA
  2. 2.Endoscopy Division, National Cancer Center HospitalTokyoJapan
  3. 3.Department of Thoracic and Cardiovascular SurgeryCleveland Clinic FoundationClevelandUSA
  4. 4.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland ClinicClevelandUSA

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