title: Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series.
abstract: BACKGROUND
  Although endoscopic submucosal dissection (ESD) is becoming accepted as an established treatment for superficial esophageal squamous cell neoplasia, the majority of data on this endoscopic modality has been provided by Japanese series.
  
  
  OBJECTIVE
  To assess the efficacy and safety of ESD for esophageal squamous cell neoplasia in a consecutive series of patients treated in a Western setting.
  
  
  METHODS
  Single-center, prospective observational study.
  
  
  METHODS
  From January 2005 to July 2008, 20 patients with superficial esophageal squamous cell neoplasia were treated by ESD.
  
  
  METHODS
  Rates of en bloc resection, complete resection, and complications were evaluated as short-term outcomes. Overall survival, local or distant recurrence, and postoperative stricture rates were evaluated as long-term outcomes.
  
  
  RESULTS
  ESD was performed in 20 patients (mean age 64 years, range 46-81 years; 16 men). The mean size of the lesion was 32 mm (range 15-60 mm); it was 30 mm or larger in 14 patients (70%). The mean time of ESD was 89 minutes (range 58-180 minutes). En bloc resection with resection-free margins was achieved in 18 patients (90%), whereas 2 patients presented with incomplete or indeterminate resection. Two cases (10%) of mediastinal emphysema without overt perforation and 1 case (5%) of post-ESD symptomatic stricture were reported. No local or distant post-ESD recurrence occurred in those with resection-free margins at a median follow-up of 18 months.
  
  
  CONCLUSIONS
  Small number of patients and limited follow-up.
  
  
  CONCLUSIONS
  This Western series study confirms that ESD is a potentially curative treatment for superficial esophageal squamous cell neoplasia. Early and late complication rates were comparable to those of Japanese series. ESD should be probably considered as the treatment of choice in all large lesions amenable to endoscopic treatment.
authors.affiliation: Gastroenterology Department, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carlino
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rando
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Strangio
authors.forename: Fabio
authors.initials: F
authors.lastname: Romeo
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Nicita
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies