Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.3965
Peer-review started: July 9, 2018
First decision: July 17, 2018
Revised: July 23, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 21, 2018
Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.
Core tip: Endoscopic eradication therapy (EET) plays a pivotal role in the management of patients with early esophageal cancer who are at very low risk for lymph node metastases. The main advantage of EET over surgery is the lower morbidity and mortality rates with similar cure rates, five-year survival rates and better quality of life. These excellent outcomes are tempered by the need for multiple treatment sessions for complete eradication and risk of post eradication recurrences. Careful patient selection by a multidisciplinary approach and patient compliance are crucial for treatment success.