Endoscopic Therapy for Superficial Esophageal Cancer

  • Anna M. Lipowska
  • Irving WaxmanEmail author


Staging and treatment of superficial esophageal cancer has greatly evolved over the last decade. Through an improved understanding of the risks of locoregional invasion and distant metastasis in T1a tumors, treatment has moved away from esophagectomy to less invasive modalities. Recent advances in endoscopic resection techniques have allowed for a safe and efficient alternative to surgical resection in this population. Endoscopic resection can be performed through either endoscopic mucosal resection or endoscopic submucosal dissection. Following resection, ablative therapy of the remaining Barrett’s esophagus segment is recommended in adenocarcinoma. This chapter will provide an overview of available endoscopic resection techniques, their risks, benefits, and the most updated clinical practice recommendations for the treatment of superficial esophageal adenocarcinoma and squamous cell carcinoma.


Esophageal adenocarcinoma Squamous cell carcinoma Endoscopic mucosal resection Endoscopic submucosal dissection Ablative therapy 


  1. 1.
    Ajani JA, D’Amico TA, Almhanna K, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(2):194–227.CrossRefGoogle Scholar
  2. 2.
    Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6(2):119–30.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schlottmann F, Patti MG. Current concepts in treatment of Barrett’s esophagus with and without dysplasia. J Gastrointest Surg. 2017;21(8):1354–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Merkow RP, Bilimoria KY, Keswani RN, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. 2014;106(7):dju133.CrossRefPubMedGoogle Scholar
  5. 5.
    Leers JM, DeMeester SR, Oezcelik A, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg. 2011;253(2):271–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg. 2009;87(4):1048–54. discussion 1054–1045.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol. 2013;19(9):1424–37.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Berry MF. Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis. 2014;6(Suppl 3):S289–97.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Young PE, Gentry AB, Acosta RD, Greenwald BD, Riddle M. Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus. Clin Gastroenterol Hepatol. 2010;8(12):1037–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):242–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Sharma P, Katzka DA, Gupta N, et al. Quality indicators for the management of Barrett’s esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium. Gastroenterology. 2015;149(6):1599–606.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of G. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111(1):30–50. quiz 51.CrossRefPubMedGoogle Scholar
  13. 13.
    Lordick F, Mariette C, Haustermans K, Obermannova R, Arnold D, Committee EG. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v50–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Terheggen G, Horn EM, Vieth M, et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut. 2017;66(5):783–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Schlottmann F, Patti MG, Shaheen NJ. Endoscopic treatment of high-grade dysplasia and early esophageal cancer. World J Surg. 2017;41(7):1705–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Pech O, May A, Manner H, et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology. 2014;146(3):652–60. e651.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Newton AD, Predina JD, Xia L, et al. Surgical management of early-stage esophageal adenocarcinoma based on lymph node metastasis risk. Ann Surg Oncol. 2018;25(1):318–25.CrossRefPubMedGoogle Scholar
  19. 19.
    Wani S, Drahos J, Cook MB, et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc. 2014;79(2):224–32. e221.CrossRefPubMedGoogle Scholar
  20. 20.
    Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003;75(1):217–22. discussion 222.CrossRefPubMedGoogle Scholar
  21. 21.
    Peters FP, Kara MA, Rosmolen WD, et al. Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol. 2006;101(7):1449–57.CrossRefPubMedGoogle Scholar
  22. 22.
    Bahin FF, Jayanna M, Hourigan LF, et al. Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma. Gastrointest Endosc. 2016;83(1):68–77.CrossRefPubMedGoogle Scholar
  23. 23.
    Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Holscher AH. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg. 2011;254(1):67–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Chennat J, Konda VJ, Ross AS, et al. Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma--an American single-center experience. Am J Gastroenterol. 2009;104(11):2684–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Li C, Yamashita DT, Hawel JD, Bethune D, Henteleff H, Ellsmere J. Endoscopic mucosal resection versus esophagectomy for intramucosal adenocarcinoma in the setting of Barrett’s esophagus. Surg Endosc. 2017;31(10):4211–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Small AJ, Sutherland SE, Hightower JS, et al. Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett’s esophagus. Gastrointest Endosc. 2015;81(5):1158–66. e1151–1154.CrossRefPubMedGoogle Scholar
  27. 27.
    Chu JN, Choi J, Tramontano A, et al. Surgical vs endoscopic management of T1 esophageal adenocarcinoma: a modeling decision analysis. Clin Gastroenterol Hepatol. 2018;16(3):392–400.e7.CrossRefPubMedGoogle Scholar
  28. 28.
    Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg. 2013;257(6):1032–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR. Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg. 2005;242(4):566–73. discussion 573–565.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Endo M, Yoshino K, Kawano T, Nagai K, Inoue H. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus. 2000;13(2):125–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Ajani JA, Barthel JS, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers. J Natl Compr Cancer Netw. 2011;9(8):830–87.CrossRefGoogle Scholar
  32. 32.
    Katada C, Muto M, Momma K, et al. Clinical outcome after endoscopic mucosal resection for esophageal squamous cell carcinoma invading the muscularis mucosae--a multicenter retrospective cohort study. Endoscopy. 2007;39(9):779–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Ishihara R, Iishi H, Takeuchi Y, et al. Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc. 2008;67(6):799–804.CrossRefPubMedGoogle Scholar
  34. 34.
    Takahashi H, Arimura Y, Masao H, et al. Endoscopic submucosal dissection is superior to conventional endoscopic reion as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72(2):255–64. 264 e251–252.CrossRefPubMedGoogle Scholar
  35. 35.
    Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal reion for tumors of the gastrointestinal tract. Endoscopy. 2009;41(9):751–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Tanaka T, Matono S, Mori N, Shirouzu K, Fujita H. T1 squamous cell carcinoma of the esophagus: long-term outcomes and prognostic factors after esophagectomy. Ann Surg Oncol. 2014;21(3):932–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Probst A, Aust D, Markl B, Anthuber M, Messmann H. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy. 2015;47(2):113–21.PubMedGoogle Scholar
  38. 38.
    Park JS, Youn YH, Park JJ, Kim JH, Park H. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc. 2016;49(2):168–75.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Zhang YQ, Chen T, Zhang C, et al. Endoscopic submucosal dissection for superficial proximal esophageal neoplasia is highly successful. Ann Surg. 2017;266(6):995–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Das A, Singh V, Fleischer DE, Sharma VK. A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data. Am J Gastroenterol. 2008;103(6):1340–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Teoh AY, Chiu PW, Yu Ngo DK, Wong SK, Lau JY, Ng EK. Outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection in management of superficial squamous esophageal neoplasms outside Japan. J Clin Gastroenterol. 2010;44(9):e190–4.CrossRefPubMedGoogle Scholar
  42. 42.
    May A, Gossner L, Behrens A, et al. A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc. 2003;58(2):167–75.CrossRefPubMedGoogle Scholar
  43. 43.
    Zhang YM, Boerwinkel DF, Qin X, et al. A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus. Endoscopy. 2016;48(4):330–8.PubMedGoogle Scholar
  44. 44.
    Pouw RE, van Vilsteren FG, Peters FP, et al. Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia. Gastrointest Endosc. 2011;74(1):35–43.CrossRefPubMedGoogle Scholar
  45. 45.
    Subramaniam S, Chedgy F, Longcroft-Wheaton G, et al. Complex early Barrett’s neoplasia at 3 Western centers: European Barrett’s Endoscopic Submucosal Dissection Trial (E-BEST). Gastrointest Endosc. 2017;86(4):608–18.CrossRefPubMedGoogle Scholar
  46. 46.
    Yang D, Coman RM, Kahaleh M, et al. Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc. 2017;86(4):600–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57(9):1200–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Neuhaus H, Terheggen G, Rutz EM, Vieth M, Schumacher B. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy. 2012;44(12):1105–13.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Chicago, Center for Endoscopic Research and TherapeuticsChicagoUSA

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