Efficacy and safety of the water pressure method for endoscopic submucosal dissection in superficial pharyngeal cancer

Noriko Matsuura; Motohiko Kato; Kentaro Iwata; Kurato Miyazaki; Teppei Masunaga; Yoko Kubosawa; Mari Mizutani; Yukie Hayashi; Motoki Sasaki; Tomohisa Sujino; Kaoru Takabayashi; Teppei Akimoto; Yusaku Takatori; Atsushi Nakayama; Mariko Sekimizu; Hiroyuki Ozawa; Naohisa Yahagi

doi:10.1055/a-2284-9184

Efficacy and safety of the water pressure method for endoscopic submucosal dissection in superficial pharyngeal cancer

Endosc Int Open. 2024 Apr 26;12(4):E621-E628. doi: 10.1055/a-2284-9184. eCollection 2024 Apr.

Authors

Noriko Matsuura¹, Motohiko Kato², Kentaro Iwata^{1

3}, Kurato Miyazaki^{1

3}, Teppei Masunaga¹, Yoko Kubosawa^{1

3}, Mari Mizutani^{1

3}, Yukie Hayashi³, Motoki Sasaki¹, Tomohisa Sujino², Kaoru Takabayashi², Teppei Akimoto¹, Yusaku Takatori¹, Atsushi Nakayama¹, Mariko Sekimizu⁴, Hiroyuki Ozawa⁴, Naohisa Yahagi¹

Affiliations

¹ Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan.
² Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Shinjuku-ku, Japan.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan.
⁴ Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinjuku-ku, Japan.

Abstract

Background and study aims Superficial pharyngeal cancers can be cured with transoral surgery (TOS), which preserves organ function and quality of life. Pharyngeal endoscopic submucosal dissection (ESD) is challenging to perform because of limited maneuverability and complex anatomical features. The water pressure method (WPM) is useful for natural traction techniques during ESD and is potentially useful for pharyngeal ESD. This study aimed to investigate the short-term outcomes of WPM-ESD for pharyngeal lesions. Patients and methods Therapeutic outcomes of patients who underwent WPM-ESD for pharyngeal lesions at Keio University between May 2019 and February 2022 were retrospectively analyzed. Results Twenty-one pharyngeal lesions treated with WPM-ESD were analyzed. Three lesions were located in the oropharynx and 18 in the hypopharynx. All ESD procedures were performed under general anesthesia. The endoscopic en bloc resection rate was 100%. The median procedure time was 15 minutes (range 4-45 minutes). All patients were successfully extubated on the day of ESD. No serious adverse events (AEs) related to WPM-ESDs were observed. None of the patients required nasogastric intubation, percutaneous endoscopic gastrostomy, or tracheotomy. The median fasting time and hospital stay were 2 days (range 2-5 days) and 6 days (range 6-10 days), respectively. All the histological results indicated squamous cell carcinoma. The complete histologic resection rate was 76.2%. Conclusions WPM-ESD achieved a high en bloc resection rate and short procedure time without serious AEs. Thus, it may be a useful treatment for pharyngeal lesions.

Keywords: Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE); Endoscopic resection (ESD, EMRc, ...); Endoscopy Upper GI Tract; Pharyngeal cancer.

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/).