Community standard practices in the endoscopic treatment of esophageal squamous cell carcinoma: a nationwide survey in Japan.

BACKGROUND

In Japan, endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). Although clinical guidelines outline indications, additional treatment, and stricture prevention, real-world practice patterns remain insufficiently characterized. The present nationwide survey aimed to clarify the current endoscopic management of ESCC in Japan.

METHODS

A web-based, 20-item multiple-choice questionnaire was distributed to endoscopists performing upper gastrointestinal endoscopy at least weekly. Invitations were disseminated through the mailing lists of the Japan Esophageal Society and the individual mailing lists of core study members. The survey assessed diagnostic strategies, endoscopic treatment selection, indications for additional therapy after ESD, and approaches to stricture prevention.

RESULTS

Altogether, 303 endoscopists who had performed endoscopic treatment for ESCC within the preceding year were enrolled. Most respondents reported using ESD exclusively. For clinical muscularis mucosa (MM) or shallow submucosa (SM1) lesions, treatment selection depended on circumferential extent, with ESD performed on 95.0% of patients with lesions involving < 1/2 of the circumference and ESD, chemoradiotherapy, and surgery conducted at similar frequencies for circumferential lesions. Decisions regarding additional treatment post-ESD for pathological MM or SM1 lesions were strongly influenced by lymphovascular invasion. Stricture prevention strategies varied according to the extent of mucosal defect, with steroid injection preferred for defects involving ≥ 1/2 but < 3/4 of the circumference and combined local steroid injection and oral steroids for circumferential defects.

CONCLUSIONS

Although most practices align with guideline recommendations, substantial variability persists in areas lacking explicit guidance, highlighting the need for stronger evidence to support standardized clinical decision-making.