Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer

Summary Background To assess the outcomes of patients with early esophageal cancer and high-grade dysplasia comparing esophagectomy, the historical treatment of choice, to endoscopic eradication therapy (EET). Methods Retrospective cohort study of consecutive patients with early esophageal cancer/high-grade dysplasia, treated between 2000 and 2018 at a tertiary center. Primary outcomes were all-cause and disease-specific mortality assessed by multivariable Cox regression and a propensity score matching sub analysis, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, tumor grade (G1/2 vs. G3), tumor stage, and lymphovascular invasion. Secondary outcomes included complications, hospital stay, and overall costs. Results Among 269 patients, 133 underwent esophagectomy and 136 received EET. Adjusted survival analysis showed no difference between groups regarding all-cause mortality (HR 1.85, 95% CI 0.73, 4.72) and disease-specific mortality (HR 1.10, 95% CI 0.26, 4.65). In-hospital and 30-day mortality was 0% in both groups. The surgical group had a significantly higher rate of complications (Clavien–Dindo ≥3 26.3% vs. endoscopic therapy 0.74%), longer in-patient stay (median 14 vs. 0 days endoscopic therapy) and higher hospital costs(£16 360 vs. £8786 per patient). Conclusion This series of patients treated during a transition period from surgery to EET, demonstrates a primary endoscopic approach does not compromise oncological outcomes with the benefit of fewer complications, shorter hospital stays, and lower costs compared to surgery. It should be available as the gold standard treatment for patients with early esophageal cancer. Those with adverse prognostic features may still benefit from esophagectomy.

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Endoscopic Mucosal Resection (EMR) for High Grade Dysplasia (HGD) and Early Esophageal Cancer

The American Journal of Gastroenterology ◽

10.14309/00000434-200509001-00079 ◽

2005 ◽

Vol 100 ◽

pp. S49-S50

Author(s):

Emad Y. Rahmani ◽

Kathy L. Arney ◽

Carolyn Turpin

Keyword(s):

Esophageal Cancer ◽

Endoscopic Mucosal Resection ◽

High Grade Dysplasia ◽

High Grade ◽

Early Esophageal Cancer ◽

Mucosal Resection

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An open-label, prospective trial of cryospray ablation for Barrett's esophagus high-grade dysplasia and early esophageal cancer in high-risk patients

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.02.006 ◽

2009 ◽

Vol 70 (4) ◽

pp. 635-644 ◽

Cited By ~ 105

Author(s):

John A. Dumot ◽

John J. Vargo ◽

Gary W. Falk ◽

Lorraine Frey ◽

Rocio Lopez ◽

...

Keyword(s):

Esophageal Cancer ◽

High Risk ◽

Barrett's Esophagus ◽

Prospective Trial ◽

High Grade Dysplasia ◽

High Grade ◽

Early Esophageal Cancer ◽

Open Label ◽

High Risk Patients ◽

Risk Patients

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Novel Transgastric Endoluminal Segmental Esophagectomy and Primary Anastomosis Technique: A Hybrid Transgastric Thoracoscopic Esophagectomy for the Treatment of High Grade Dysplasia and Early Esophageal Cancer in a Porcine Ex vivo Model

Frontiers in Surgery ◽

10.3389/fsurg.2021.676031 ◽

2021 ◽

Vol 8 ◽

Author(s):

Anton Kvasha ◽

Muhammad Khalifa ◽

Seema Biswas ◽

Moaad Farraj ◽

Zakhar Bramnik ◽

...

Keyword(s):

Esophageal Cancer ◽

Endoscopic Resection ◽

Ex Vivo ◽

Primary Anastomosis ◽

Circular Stapler ◽

High Grade Dysplasia ◽

High Grade ◽

Early Esophageal Cancer ◽

Ex Vivo Model ◽

Surgical Equipment

Multiple modalities are currently employed in the treatment of high grade dysplasia and early esophageal carcinoma. While they are the subject of ongoing investigation, surgery remains the definitive modality for oncological resection. Esophagectomy, however, is traditionally a challenging surgical procedure and carries a significant incidence of morbidity and mortality. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are considerably less invasive alternatives to esophagectomy in the diagnosis and treatment of high grade dysplasia, early esophageal squamous cell carcinoma and adenocarcinoma. However, many early esophageal cancer patients, with favorable histology, who could benefit from endoscopic resection, are referred for formal esophagectomy due to lesion characteristics such as unfavorable lesion morphology or recurrence after previous endoscopic resection. In this study we present a novel, hybrid thoracoscopic transgastric endoluminal segmental esophagectomy with primary anastomosis for the potential treatment of high grade dysplasia and early esophageal cancer in a porcine ex vivo model as a proposed bridge between endoscopic resection and the relatively high mortality and morbidity formal esophagectomy procedure. The novel technique consists of thoracoscopic esophageal mobilization in addition to transgastric endoluminal segmental esophagectomy and anastomosis utilizing a standard circular stapler. The technique was found feasible in all experimental subjects. The minimally invasive nature of this novel procedure as well as the utility of basic surgical equipment and surgical skill is an important attribute of this method and can potentially make it a treatment option for many patients who would otherwise be referred for a formal esophagectomy.

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PS02.096: ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL HIGH-GRADE SQUAMOUS DYSPLASIA: A CASE REPORT

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.096 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 148-148

Author(s):

Hui Ying Khoo ◽

Kelvin Voon ◽

Shyang Yee Lim

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Endoscopic Treatment ◽

Conflicts Of Interest ◽

Uneventful Recovery ◽

Medical Illness ◽

Incomplete Resection ◽

High Grade ◽

Early Esophageal Cancer ◽

Submucosal Dissection

Abstract Background Endoscopic resection is a novel therapeutic technique for early esophageal cancer and it is indicated in well differentiated superficial M1 or M2 lesion. The selection criteria have been expanded to selected M3 and SM1 lesion with the advancement of endoscopic technology and detailed study of relation between depth of lesion and lymphatic spread. Methods We report a case of endoscopic submucosal dissection (ESD) for esophageal high grade dysplasia. Results Madam S, a 50-year-old lady with no known medical illness, presented with gradual dysphagia for 1 year. She had no prior history of corrosive ingestion or reflux disease. She was diagnosed with esophageal stricture and underwent esophageal dilatation twice, before she was referred to our center. Clinical examination revealed no abnormality and her BMI was 25. OGDS revealed a 1cm superficial ulcerative lesion at proximal esophagus (25cm from incisor) with abnormal capillary pattern on narrow band imaging. Biopsy revealed high grade intraepithelial neoplasia. PET-CT showed metabolically active esophageal lesion with no distant metastasis. She decided for ESD after given the option of endoscopic treatment versus esophagectomy. ESD was done (Figure 1) and she had an uneventful recovery. Histopathology revealed complete resection of high grade squamous dysplasia. Conclusion Endoscopic treatment is less invasive option for early esophageal tumour which spares patients from esophagectomy and the related morbidities. However, it carries the risk of incomplete resection, recurrence and under-staging of the disease. It also requires highly specialized center and has a steep learning curve. Careful patient selection and proper pre-operative counseling are crucial in endoscopic treatment of early esophageal cancer. Long term surveillance is needed for early detection of recurrence. Disclosure All authors have declared no conflicts of interest.

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