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World J Gastrointest Endosc. Oct 16, 2019; 11(10): 491-503
Published online Oct 16, 2019. doi: 10.4253/wjge.v11.i10.491
Resection of early esophageal neoplasms: The pendulum swings from surgical to endoscopic management
Vedha Sanghi, Hina Amin, Madhusudhan R Sanaka, Prashanthi N Thota
Vedha Sanghi, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Hina Amin, Madhusudhan R Sanaka, Prashanthi N Thota, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: All authors contributed to the conception and design, acquisition of data and drafting of manuscript; all authors approved the final version of the article, including the authorship list.
Conflict-of-interest statement: Authors deny any conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Prashanthi N Thota, MD, Staff Physician, Medical Director, Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. thotap@ccf.org
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: June 11, 2019
Peer-review started: June 19, 2019
First decision: August 2, 2019
Revised: August 9, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 16, 2019
Abstract

Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world. The standard treatment is esophagectomy which is associated with significant morbidity and mortality. This led to development of minimally invasive, organ sparing endoscopic therapies which have comparable outcomes to esophagectomy in early cancer. These include endoscopic mucosal resection and endoscopic submucosal dissection. In early squamous cell cancer, endoscopic submucosal dissection is preferred as it is associated with cause specific 5-year survival rates of 100% for M1 and M2 tumors and 85% for M3 and SM1 tumors and low recurrence rates. In early adenocarcinoma, endoscopic resection of visible abnormalities is followed by ablation of the remaining flat Barrett’s mucosa to prevent recurrences. Radiofrequency ablation is the most widely used ablation modality with others being cryotherapy and argon plasma coagulation. Focal endoscopic mucosal resection followed by radiofrequency ablation leads to eradication of neoplasia in 93.4% of patients and eradication of intestinal metaplasia in 73.1% of patients. Innovative techniques such as submucosal tunneling with endoscopic resection are developed for management of submucosal tumors of the esophagus. This review includes a discussion of various endoscopic techniques and their clinical outcomes in early squamous cell cancer, adenocarcinoma and submucosal tumors. An overview of comparison between esophagectomy and endoscopic therapy are also presented.

Keywords: Esophageal cancer, Submucosal tumors, Submucosal tunneling, Barrett’s esophagus, Dysplasia, Adenocarcinoma, Endoscopic therapy, Radiofrequency ablation, Endoscopic mucosal resection

Core tip: Advances in endoscopic therapies led to organ preserving endoscopic treatments for early esophageal cancer and submucosal tumors of the esophagus. These techniques include endoscopic mucosal resection, endoscopic submucosal dissection and submucosal tunneling endoscopic resection. Ablative techniques are useful for treatment of residual dysplasia.