title: Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20  mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD.
  
  
  METHODS
  We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS.
  
  
  RESULTS
  11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm(2). Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9/11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4/11 patients (36.4%) with resolution after 1-5 dilations.
  
  
  CONCLUSIONS
  Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.
authors.affiliation: Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
authors.forename: Laetitia
authors.initials: L
authors.lastname: Mais
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Valérie
authors.initials: V
authors.lastname: Hervieu
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D018365:Neoplasm, Residual; D061646:Operative Time; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000209:etiology; D047368:Tumor Burden