Knife-assisted endoscopic full-thickness resection of deeply invasive esophageal adenocarcinoma: a case series

BACKGROUND & AIMS Esophageal adenocarcinoma (EAC) incidence is rising globally and current therapeutic options carry substantial morbidity and mortality. We report feasibility and early outcomes of knife-assisted endoscopic full-thickness resection (kFTR) as palliative local control in non-surgical candidates. METHODS Three patients with suspected locally advanced distal EAC (clinical stage T1b–T2), no nodal or distant disease, and high Charlson Comorbidity Index scores were unfit for surgery and declined chemoradiotherapy. All consented to kFTR: a submucosal pocket was created cranial to the suspected invasive area, the muscle-retracting sign was identified and the muscularis propria was incised to access the peri-esophageal space. The lesion was dissected laterally and resected en bloc. A fully covered metal stent was placed. RESULTS Patients resumed oral intake on day 5 without major adverse events. All had pT1b sm3 EAC; two had positive vertical margins. One remains disease-free (24 months); two developed local recurrence by 6 months but remained asymptomatic at last follow-up (10 and 14 months). CONCLUSION In carefully selected, symptomatic, inoperable patients, kFTR achieved short-to-medium term symptom control for locally advanced EAC with acceptable safety.