Aadam A A, Abe S
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Dis Esophagus. 2018 Jul 1;31(7). doi: 10.1093/dote/doy021.
Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality for superficial esophageal cancer. ESD offers a distinct advantage given the ability to perform en bloc resection enabling accurate histopathologic assessment. Data from published literature has established ESD as the preferred option in the treatment of superficial squamous cell carcinoma with complete resection rates of 78-100%, and a low rate recurrence of 0-2.6%. En bloc resection for esophageal SCC is curative for tumors with M1 (intrapethelial) or M2 (invasion into the lamina propria) involvement with no lymphovascular invasion. Tumors that contain lymphovascular invasion or submucosal invasion greater than 200 μm should be treated as advanced carcinomas due to the increased risk of lymph node metastasis. In contrast, the role of ESD in Barrett's esophagus is more limited due to the high rate of efficacy of EMR. A randomized control trial comparing EMR and ESD strategies found a higher R0 resection rate for ESD, but no significant difference in complete remission from neoplasia at 3 month follow up. Endoscopic ultrasound (EUS) has a limited role in the evaluation of superficial esophageal cancer. Alternatively, detailed endoscopic assessment along with magnification endoscopy or narrow band imaging, may provide greater utility than EUS. The most common adverse events of ESD in the esophagus include perforation and stricture. Perforation can often be managed by defect closure along with non-operative conservative management. Steroid administration with either topical or local injection can be effective management in stricture prevention. Continued refinement of ESD technique and innovation will overcome some of the current limitations of ESD and enable curative resection of superficial esophageal cancer as an alternative to invasive surgery.
内镜黏膜下剥离术（ESD）已发展成为一种治疗浅表食管癌的可行方法。ESD具有显著优势，因为它能够进行整块切除，从而实现准确的组织病理学评估。已发表文献中的数据表明，ESD是治疗浅表鳞状细胞癌的首选方法，其完全切除率为78%-100%，低复发率为0%-2.6%。食管鳞状细胞癌的整块切除对于M1（上皮内）或M2（侵犯固有层）且无淋巴管侵犯的肿瘤具有治愈性。对于存在淋巴管侵犯或黏膜下侵犯大于200μm的肿瘤，由于淋巴结转移风险增加，应视为进展期癌。相比之下，由于内镜下黏膜切除术（EMR）的高疗效，ESD在巴雷特食管中的作用更为有限。一项比较EMR和ESD策略的随机对照试验发现，ESD的R0切除率更高，但在3个月随访时肿瘤完全缓解方面无显著差异。内镜超声（EUS）在浅表食管癌评估中的作用有限。另外，详细的内镜评估结合放大内镜或窄带成像，可能比EUS更有用。ESD在食管中的最常见不良事件包括穿孔和狭窄。穿孔通常可通过缺损闭合及非手术保守治疗来处理。局部或局部注射类固醇可有效预防狭窄。ESD技术的持续改进和创新将克服ESD目前的一些局限性，并使浅表食管癌的治愈性切除成为侵入性手术的替代方法。
