Underwater endoscopic submucosal dissection for recurrent superficial esophageal cancer at the site of stenosis after endoscopic resection

 

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Repeated endoscopic submucosal dissection (ESD) for local recurrence after endoscopic resection can be challenging due to diffuse submucosal fibrosis. In addition, extensive esophageal ESD can lead to luminal stenosis, and ESD for recurrent lesions in the stenosis is complicated because of severe submucosal fibrosis and poor maneuverability [1] [2]. Herein, we present two cases of recurrent esophageal cancer in areas of stenosis caused by prior extensive ESD, which were successfully resected using underwater ESD with a tapered tip hood ([Video 1]).

The first case involved a 67-year-old man with an 8-mm superficial adenocarcinoma in the middle thoracic esophagus. The lesion was located inside the scar of a previous semi-circumferential ESD for long-segment Barrett’s esophageal adenocarcinoma. The second case involved an 84-year-old man with a 12-mm squamous cell carcinoma in the middle thoracic esophagus. The lesion was also located on the scar from a previous ESD and ablation therapy. These lesions were located at the stenosis site before ESD ([Fig. 1]). Underwater ESD was performed using a tapered tip hood (CAST hood; TOP Corporation, Tokyo, Japan). The 1.3 times magnified endoscopic view [3] and the clear underwater visibility allowed precise dissection of the fibrotic area. The tapered design of the hood prevented collisions with the esophageal wall ([Fig. 2], [Fig. 3]). Consequently, we achieved curative en bloc resection of the lesions without adverse events.

ESD for superficial esophageal cancers has demonstrated an excellent R0 resection rate regardless of tumor size and circumference; however, post-ESD stenosis remains an issue. Moreover, the high annual incidence of metachronous cancers after esophageal ESD occasionally results in recurrent lesions at the site of stenosis. This report suggests that underwater ESD with a tapered tip hood is a beneficial approach due to clear visibility, improved reachability, and maneuverability of the technique at the stenosis site, allowing safe and effective ESD.

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Publication History

Article published online:
28 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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