328. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL CARCINOMA INVOLVING THE ENTIRE ESOPHAGUS: SHORT-TERM RESULTS

Background

The treatment of superficial esophageal carcinoma involving the entire esophagus remains challenging due to the difficulty in accurate preoperative diagnosis and the complexity of the Endoscopic Submucosal Dissection (ESD) technique. The management of esophageal stricture following ESD also remains controversial. In this study, we analyzed the advantages and disadvantages of ESD for superficial whole circumferential esophageal carcinoma in our hospital, based on short-term results.

Methods

We retrospectively analyzed 10 patients diagnosed with superficial esophageal carcinoma involving the entire circumference and treated with ESD from January 2021 to the present. We evaluated the accuracy of preoperative diagnosis, treatment-related complications of ESD, post-ESD stenosis, and adverse events associated with stenosis prophylaxis.

Treatment Course: The primary treatment consisted of circumferential resection under general anesthesia followed by local injection of 120–320 mg of steroids into the ulcer after resection. Patients were started on a diet 2–3 days after surgery and initiated oral steroid therapy starting with 30 mg with PPI and Sulfamethoxazole Trimethoprim. The dose of steroids was gradually reduced by 5 mg every 3 weeks for a total of 18 weeks.

Results

The study included 7 males and 3 females with a mean age of 72.9 years. The lesions were located in Upper 1, Middle 5, and Lower 4. The average dissection time was 89.1 minutes, the mean length of endoscopic longitudinal mucosal defects was 70 mm, and the en bloc resection rate was 100%. The histological depth was EP/LPM 5, MM/SM 13, and SM2 or deeper 2. The accuracy of preoperative diagnosis was 80%, but all SM2 lesions were underdiagnosed as SM1. No ESD-related adverse events were observed in any case. Two patients with SM2 after ESD underwent additional surgery. Stenosis occurred in 25% of cases. Steroid-related events included drug-induced liver dysfunction in 4 cases, esophageal candida in 2 cases, pulmonary tuberculosis in 1 case, and delayed perforation in 1 case.

Conclusion

ESD for superficial esophageal carcinoma involving the entire esophagus can be safely and effectively performed. Steroid administration may be useful for preventing post-ESD stenosis, but its management requires attention as it may cause adverse events.