S2193 Utilizing Circumferential Endoscopic Submucosal Dissection for Early Esophageal Neoplasia

Introduction: Endoscopic Submucosal Dissection (ESD) is a minimally invasive technique developed in Japan that allows for en bloc resection of neoplastic lesions in the gastrointestinal tract. Circumferential ESD (cESD) is an advanced technique in which the entire circumference of the esophageal mucosa and submucosa is resected en bloc for early stage and primarily superficial esophageal cancers. Methods: We conducted a retrospective review of 9 cases of cESD performed by multiple advanced endoscopists across different hospitals in the United States. Data collection included indication for the procedure along with biopsy findings, intra and post procedural complications. Results: Of the 9 cases reviewed, en bloc resection was achieved in all cases and all but one had histologic confirmation of R0 resection. Stents were placed in 6 of the 9 cases for stricture prevention, and 3 of those also received triamcinolone. Post procedure stricture formation occurred in 67% of the patients, regardless of intraprocedural stricture prevention strategies, all of whom required multiple sessions of balloon dilation and steroid injections. 1 out of the 9 patients developed a severe complication due to esophageal perforation requiring extended ICU stay and surgical intervention. Recurrence was noted in only 1 of the 9 cases that did not achieve R0 resection. Conclusion: ESD as a technique overall has an increasing role in the West in treatment of esophageal neoplasia. Patients with early circumferential esophageal neoplasias were traditionally treated with esophagectomy but cESD offers patients a less invasive alternative especially for those that are not surgical candidates. Post ESD stricturing is a well known adverse event as noticed in 67% of the cases we reviewed. Rare but serious complications, such as esophageal perforation, is also a risk. With careful patient selection and follow up, cESD should be considered more often in the management of esophageal neoplasm.