Endoscopic submucosal dissection of high grade intraepithelial neoplasia of the head and neck in a patient after surgical resection of esophageal cancer

AbstractAnal intraepithelial neoplasia (AIN) is a precursor of anal carcinoma. Conventional therapy is based on topical and local ablative approaches. However, the recurrence rates are very high, leading to repetitive treatment sessions and need for long-term surveillance. Endoscopic submucosal dissection (ESD) is an established treatment for malignant early neoplasias of the gastrointestinal tract, especially in the esophagus, stomach, and colorectum. Japanese centers have reported few cases of ESD for early anal carcinoma. We report a case of high-grade AIN diagnosed with magnifying narrow-band imaging and chromoendoscopy that was resected R0 with ESD en bloc.

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Comparative analysis of differences between preoperative endoscopic biopsy and postoperative pathological examination for diagnosis of gastric intraepithelial neoplasia

Journal of International Medical Research ◽

10.1177/0300060521994929 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199492

Author(s):

Yangqing Wu ◽

Jianzhong Sang ◽

Jianbo Zhou ◽

Ying Fang

Keyword(s):

Endoscopic Submucosal Dissection ◽

Intraepithelial Neoplasia ◽

Endoscopic Biopsy ◽

Pathological Examination ◽

Low Grade ◽

High Grade ◽

Original Diagnosis ◽

Submucosal Dissection ◽

Low Grade Dysplasia ◽

Pathological Tissues

Objective This study was performed to compare the differences between preoperative endoscopic biopsy (PEB) and postoperative pathological examination (PPE) for diagnosis of gastric intraepithelial neoplasia (GIN). Methods From September 2016 to July 2019, 188 consecutive patients with GIN at Yuyao People’s Hospital were retrospectively analyzed. The 188 patients had 218 GIN lesions. All patients underwent PEB and either endoscopic submucosal dissection or surgical treatment. PPE was performed on pathological tissues that had been surgically removed. Results Among 138 cases of low-grade dysplasia (LGD) diagnosed by PEB, 46 were upgraded to high-grade dysplasia (HGD), 20 were upgraded to early gastric cancer (EGC), and 2 were downgraded to inflammation after PPE. Among 42 cases of HGD, 23 were upgraded to EGC, 2 were downgraded to LGD, and 2 were downgraded to inflammation after PPE. Among 38 cases of EGC, 1 was downgraded to HGD and 2 were downgraded to LGD after PPE. The original diagnosis was maintained after the operation in 120 cases of GIN. Conclusion Biopsy did not fully reflect the lesions of GIN. Biopsy review should be actively performed, and the lesions should be clarified by endoscopic submucosal dissection or surgery.

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Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

Case Reports in Otolaryngology ◽

10.1155/2017/1341059 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Kenro Kawada ◽

Tatsuyuki Kawano ◽

Taro Sugimoto ◽

Kazuya Yamaguchi ◽

Yuudai Kawamura ◽

...

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Head And Neck ◽

Anterior Wall ◽

Transoral Surgery ◽

Cervical Esophageal Cancer ◽

En Bloc ◽

Swallowing Function ◽

Transnasal Endoscopy ◽

Submucosal Dissection

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here.Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection.Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection.Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

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Histopathological Characteristics and Therapeutic Outcomes of Endoscopic Submucosal Dissection for Gastric High-Grade Intraepithelial Neoplasia

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2020.0035 ◽

2021 ◽

Author(s):

Hai-Han Zhang ◽

Muhammad Djaleel Soyfoo ◽

Jiu-Liang Cao ◽

Huai-Ming Sang ◽

Shun-Fu Xu ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Intraepithelial Neoplasia ◽

High Grade ◽

Submucosal Dissection ◽

Therapeutic Outcomes

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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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Efficacy of Additional Surgical Resection After Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

Anticancer Research ◽

10.21873/anticanres.11956 ◽

2017 ◽

Vol 37 (9) ◽

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Surgical Resection ◽

Superficial Esophageal Cancer ◽

Submucosal Dissection

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PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.146 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 162-162

Author(s):

Yoshiki Taniguchi ◽

Koji Tanaka ◽

Yasuhiro Miyazaki ◽

Tomoki Makino ◽

Tsuyoshi Takahashi ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Cell Carcinoma ◽

Squamous Cell ◽

Tumor Invasion ◽

Pathological Examination ◽

Submucosal Layer ◽

Cervical Esophageal Cancer ◽

Submucosal Dissection

Abstract Background We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection. Methods The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction. Results After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful. Conclusion There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice. Disclosure All authors have declared no conflicts of interest.

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