Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.435
Peer-review started: June 15, 2015
First decision: July 13, 2015
Revised: July 30, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: January 7, 2016
Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD.
Core tip: The digestive endoscopic tunnel technique (DETT) innovatively broke the traditional boundaries between medicine and surgery and has been a recent research hotspot. Based on the submucosal tunnel concept, endoscopic submucosal tunnel dissection (ESTD) was introduced by us to treat large superficial esophageal squamous cell neoplasms, with excellent results. Studies from different centers also achieved favorable results, and ESTD has become an important part of DETT in China. Therefore, we conducted a literature review and provided detailed information on indications, standard procedures, outcomes, and complications of ESTD.