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[PDF: Members Only] J.Jpn. Surg. Soc.. 121(4): 423-428, 2020
Feature topic
CURRENT STATUS AND OUTLOOK OF ENDOSCOPIC TREATMENT FOR SUPERFICIAL ESOPHAGEAL CANCER
Endoscopy allows for the screening, early diagnosis, treatment, and follow-up of superficial esophageal cancer. Lugol chromoendoscopy is known to be an effective screening technique for early esophageal cancer, although image-enhanced endoscopy techniques such as narrow-band imaging are being developed. Endoscopic resection emerged as a less-invasive alternative for the treatment of superficial esophageal cancer and is currently the gold standard. Endoscopic mucosal resection was the first endoscopic treatment used, with the downside of having higher recurrence rates related to piecemeal resection. Endoscopic submucosal dissection (ESD) was developed for en bloc resection. This technique results in accurate evaluation of resection margins, high curative resection rates, and low recurrence rates. However, postprocedural stricture is common after ESD for extensive tumors, especially in cases that underwent complete or semi-complete circular dissection. Steroids play an irreplaceable role in preventing esophageal stricture after endoscopic resection. The combination of endoscopic resection and chemoradiotherapy is considered to be a minimally invasive treatment for patients with stage I esophageal cancer. Furthermore, photodynamic therapy (PDT) showed promising efficacy in treating local failure after chemoradiotherapy for esophageal cancer. Endoscopic treatment continues to play an important role in achieving locoregional control in patients with early esophageal cancer.
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