Technical feasibility and outcomes of endoscopic submucosal dissection for superficial esophageal cancer in diverticula: a case series study (with video).

BACKGROUND AND STUDY AIMS: Superficial esophageal cancer (SEC) within a diverticulum is extremely rare and poses a high risk of perforation during endoscopic submucosal dissection (ESD), presenting unique technical challenges. This study aims to evaluate the feasibility, safety, and efficacy of ESD for treating SEC in diverticula.

PATIENTS AND

METHODS

The retrospective study was conducted on patients diagnosed endoscopically with SEC in a diverticulum who subsequently underwent ESD with histological confirmation of esophageal cancer. Data on demographics, closure methods, incidence of adverse events, histopathological characteristics, and prognostic outcomes were collected from medical records and video recordings of endoscopic procedures and analyzed.

RESULTS

Twelve patients were enrolled, and R0 resection was achieved in all cases. Post-ESD wound management varied, tailored to the defect characteristics: titanium clips were used to close wounds with a preserved superficial muscular layer in five patients (5/12, 41.7%), while endoscopic hand-suturing-developed by our research team primarily for closing large mucosal defects after endoscopic resection of colorectal tumors-was performed in three patients (3/12, 25.0%) with defects in the intrinsic muscular layer. Four patients (4/12, 33.3%) with small defects in the muscularis propria were left untreated. None of the patients experienced serious adverse events, such as post-operative bleeding or perforation, and there were no cases of recurrence or metastasis during follow-up.

CONCLUSION

This study provides evidence supporting ESD as a feasible, effective, and safe treatment for SEC in diverticula. Tailoring closure techniques to the defect characteristics is crucial for preventing complications and achieving optimal clinical outcomes.