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, 2019, 2836860
eCollection

Clinical Outcomes and Adverse Events of Endoscopic Submucosal Dissection for Gastric Tube Cancer After Esophagectomy

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Clinical Outcomes and Adverse Events of Endoscopic Submucosal Dissection for Gastric Tube Cancer After Esophagectomy

Ko Watanabe et al. Gastroenterol Res Pract.

Abstract

Background and aim: The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric tube cancer (GTC) after esophagectomy remain unclear. The aim of this study was to evaluate the clinical outcomes and safety of ESD for GTC.

Patients and methods: Twenty GTC lesions in 18 consecutive patients who underwent ESD between February 2008 and June 2018 were included in this retrospective study. The endpoints were the treatment outcomes of ESD (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate), the adverse events following ESD, and the long-term outcomes.

Results: The en bloc resection rate was 100%, while the complete en bloc resection rate and curative resection rate were 80% each. Adverse events were observed in 16.7% (3/18) of patients: one postoperative bleeding, 1 intraoperative perforation that required emergency surgery, and 1 pyothorax that required chest drainage. The 1-, 3-, and 5-year overall survival rates were 100%, 70.9%, and 70.9%, respectively. Although local recurrence was detected in 1 case of noncurative resection, no GTC- or ESD-related deaths were observed.

Conclusion: ESD for GTC was feasible and acceptable to enable en bloc resection and to prevent cancer death. However, ESD for GTC should be performed more carefully than common gastric ESD because serious adverse events specific to the gastric tube may occur.

Figures

Figure 1
Figure 1
(a) An endoscopic image obtained during endoscopic submucosal dissection (ESD). Perforation occurred during the submucosal dissection (yellow arrow). (b) An endoscopic image obtained during ESD. Endoloops and endoclips were used in an attempt to close the perforation during ESD after the lesion was resected en bloc. (c) A computed tomography (CT) image taken immediately after ESD. CT revealed refluxed gastric and duodenal juice that leaked outside of the gastric tube (yellow arrow). (d) A CT image obtained the following day. CT revealed that the fluid had spread extensively within the mediastinum (yellow arrow), which led to the development of mediastinitis.
Figure 2
Figure 2
(a) An endoscopic image obtained during endoscopic submucosal dissection (ESD). White light imaging revealed 2 synchronous gastric tube cancers (yellow and white arrows) at the posterior wall of the lower gastric tube. (b) An endoscopic image obtained during ESD. Both lesions were resected en bloc in the same piece without perforation. (c) A computed tomography (CT) image obtained 2 days after ESD. CT revealed right pleural effusion (yellow arrow). The dilated and tortuous gastric tube in the posterior mediastinal reconstruction route markedly protruded into the right thoracic cavity, close to the pleura (white arrow). (d) A CT image obtained 3 weeks after ESD. CT revealed pyothorax of the right chest (yellow arrow).
Figure 3
Figure 3
Overall survival rate following endoscopic submucosal dissection (ESD) for gastric tube cancer (GTC) using the Kaplan-Meier method. The 1-, 3-, and 5-year overall survival rates were 100%, 70.9%, and 70.9%, respectively.

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