Mediastinal emphysema after salvage ESD for residual esophageal cancer post-radiotherapy

Salvage endoscopic submucosal dissection (ESD) is increasingly used for superficial esophageal squamous cell carcinoma (ESCC) after radiotherapy (RT), particularly for residual lesions. However, RT-induced fibrosis and vascular changes render the procedure technically challenging and increase the risk of complications. Here, we report a case of superficial ESCC treated with RT, in which salvage ESD was performed for a persistent residual lesion. Although en bloc resection was achieved, the patient developed grade I mediastinal emphysema that was successfully managed conservatively with antibiotics. This case highlights the importance of appropriate patient selection, careful intraoperative techniques, and close postoperative monitoring to minimize complications and ensure successful outcomes after salvage ESD for post-RT esophageal cancer.