Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2878
Peer-review started: March 17, 2018
First decision: April 18, 2018
Revised: May 2, 2018
Accepted: June 9, 2018
Article in press: June 9, 2018
Published online: July 14, 2018
To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection (ESTD) for esophageal squamous cell carcinoma (ESCC) and precancerous lesions.
ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.
A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period.
ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.
Core tip: Endoscopic submucosal tunnel dissection (ESTD) is a modified technique based on endoscopic submucosal dissection. In this paper, we found ESTD is feasible and relatively safe for treating esophageal squamous cell carcinoma (ESCC) and precancerous lesions. The en bloc rate was high, while the adverse event rate was relatively low. When treating large mucosal lesions, ESTD has a high rate of esophageal stricture and positive margin, which requires further treatment. Furthermore, we found that the pathology of preoperative biopsies had to be upgraded after ESTD, which suggests that the accuracy of biopsy to diagnose ESCC should be reconsidered.