Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Design and Setting: Retrospective study from a single institution. Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. Results: The rates of en bloc resection and complete resection were 100% and 88%, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively. Limitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.