Clinical Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma of the Esophagogastric Junction.
Endoscopic submucosal dissection (ESD) for adenocarcinoma in the esophagogastric junction (EGJ) is a technically difficult procedure. We analyzed the long-term clinical outcomes of ESD for adenocarcinoma in the EGJ to determine the feasibility of this treatment approach.



Subjects who underwent ESD for Siewert type II adenocarcinoma between December 2004 and December 2011 were eligible for this study. Clinical features and treatment outcomes were retrospectively reviewed using medical records.



A total of 88 subjects underwent ESD at our institute. The median patient age was 66 years (interquartile range [IQR] 59-71 years), and the male-to-female ratio was 10.0:1. The median tumor diameter was 20 mm (IQR 14-25 mm), and the median procedure time was 40 min (IQR 30-60 min). Adverse events occurred in nine patients (10.2 %), namely bleeding (n = 6) and suspicious microperforation (n = 3). En bloc, complete, and curative resection rates were 88.6 % (78/88), 83.0 % (73/88), and 60.2 % (53/88), respectively. In multivariate analysis, undifferentiated histology (P = 0.009) and elevated lesions (P = 0.011) were factors associated with noncurative resection. During a median follow-up period of 68.5 months, local tumor recurrence was detected in two patients (2.4 %), and the 5-year overall and disease-specific survival rates were 96.6 and 100.0 %, respectively.



ESD for the treatment of EGJ cancer may be an effective and safe treatment strategy based on favorable long-term outcomes.
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Eun Jeong
EJ
Gong
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. dohoon.md@gmail.com.
Do Hoon
do H
Kim
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Hoonsub
H
So
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Ji Yong
JY
Ahn
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Kee Wook
KW
Jung
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Jeong Hoon
JH
Lee
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Kee Don
KD
Choi
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Ho June
HJ
Song
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Gin Hyug
GH
Lee
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Hwoon-Yong
HY
Jung
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Jin-Ho
JH
Kim
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D018572:Disease-Free Survival; D000069916:Endoscopic Mucosal Resection; D004939:Esophageal Perforation / Q000453:epidemiology; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
Endoscopic submucosal dissection; Esophagogastric junction; Gastric neoplasms; Treatment outcome