Esophagus to Small Intestine
Endoscopy. 2024;56(5):325–33
Endoscopic submucosal dissection for early esophageal squamous cell carcinoma: Long-term results from a Western cohort
Background: Although endoscopic submucosal dissection (ESD) is established as first-choice treatment for early esophageal squamous cell carcinoma (ESCC) worldwide, most data are derived from Asian studies. The authors aimed to evaluate the long-term outcomes of ESD for patients with early ESCC in a Western cohort.
Methods: In this retrospective cohort study, patients with early ESCC amenable to ESD were included from 4 tertiary referral hospitals in the Netherlands between 2012 and 2017. All ESD procedures were performed by experienced endoscopists, after which the decision for additional treatment was made on a per-patient basis. Outcomes were curative resection rate, ESCC-specific survival, and overall survival.
Results: Of 68 included patients (mean age, 69 years; 34 males), ESD was technically successful in 66 (97%; 95% confidence interval [CI]: 93–100%), with curative resection achieved in 34 of 66 (52%; 95% CI: 39–64%). Among patients with non-curative resection, 15 of 32 (47%) underwent additional treatment, mainly esophagectomy (n = 10) or definitive chemoradiation therapy (n = 4). Endoscopic surveillance was preferred in 17 of 32 patients (53%), based on severe comorbidities or patient choice. Overall, 31 of 66 patients (47%) died during a median follow-up of 66 months; 8 of 31 (26%) were ESCC-related deaths. The 5-year overall and ESCC-specific survival probabilities were 62% (95% CI: 52–75%) and 86% (95% CI: 77–96%), respectively.
Conclusion: In this Western cohort with long-term follow-up, the effectiveness and safety of endoscopic submucosal dissection for early esophageal squamous cell carcinoma was confirmed, although the rate of non-curative resections was substantial. Irrespective of curative status, the long-term prognosis of these patients was limited mainly due to competing mortality.
DOI: 10.1055/a-2245-7235