Clinical impact of endoscopic submucosal dissection for superficial adenocarcinoma located at the esophagogastric junction.
BACKGROUND
Surgery is the standard treatment for neoplasms located at the esophagogastric junction (EGJ), and, recently, EMR, photodynamic therapy (PDT), or both have also been used for early stage neoplasms located at the EGJ. Endoscopic submucosal dissection (ESD) is a newly developed technique in the field of endoscopic treatments for GI neoplasms because of its high rate of en bloc resection.


OBJECTIVE
We used ESD for superficial adenocarcinoma located at the EGJ and evaluated its clinical impact.


METHODS
Twenty-five lesions of superficial adenocarcinomas located at the EGJ from 24 patients were treated with ESD between June 2001 and January 2006. An adenocarcinoma located at the EGJ was defined as a "junctional carcinoma (type II)" according to Siewert's classification.


METHODS
Complications, en bloc resection rate, curative resection rate, local recurrence, and distant metastasis were evaluated.


RESULTS
No complications except stenosis occurred. The en bloc resection rate was 100%. Seventeen lesions (72.0%) were judged as "curative resection" and showed no local or distant recurrence during a median follow-up period of 30.1 months. Seven lesions were diagnosed as "noncurative resection." Two patients underwent additional surgical resections. In 1 of 2 of the surgical resections, however, we could not identify a residual cancer. In 1 patient, who refused additional surgical resection, lung metastases were found after 3 years.


CONCLUSIONS
The limitation of the study was its retrospective design.


CONCLUSIONS
After long-term follow-up, although surgery for a noncurative resection remains a standard treatment, ESD can be adequately adopted as an effective treatment for superficial adenocarcinomas at the EGJ.
Yoshinaga
Shigetaka
S
Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Gotoda
Takuji
T
Kusano
Chika
C
Oda
Ichiro
I
Nakamura
Kazuhiko
K
Takayanagi
Ryoichi
R
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*