Clinical impact of endoscopic submucosal dissection for superficial adenocarcinoma located at the esophagogastric junction

Background: Surgery is the standard treatment for neoplasms located at the esophagogastric junction (EGJ), and, recently, EMR, photodynamic therapy (PDT), or both have also been used for early stage neoplasms located at the EGJ. Endoscopic submucosal dissection (ESD) is a newly developed technique in the field of endoscopic treatments for GI neoplasms because of its high rate of en bloc resection. Objective: We used ESD for superficial adenocarcinoma located at the EGJ and evaluated its clinical impact. Patients: Twenty-five lesions of superficial adenocarcinomas located at the EGJ from 24 patients were treated with ESD between June 2001 and January 2006. An adenocarcinoma located at the EGJ was defined as a "junctional carcinoma (type II)" according to Siewert's classification. Main Outcome Measurement: Complications, en bloc resection rate, curative resection rate, local recurrence, and distant metastasis were evaluated. Results: No complications except stenosis occurred. The en bloc resection rate was 100%. Seventeen lesions (72.0%) were judged as "curative resection" and showed no local or distant recurrence during a median follow-up period of 30.1 months. Seven lesions were diagnosed as "noncurative resection." Two patients underwent additional surgical resections. In 1 of 2 of the surgical resections, however, we could not identify a residual cancer. In 1 patient, who refused additional surgical resection, lung metastases were found after 3 years. Limitations: The limitation of the study was its retrospective design. Conclusions: After long-term follow-up, although surgery for a noncurative resection remains a standard treatment, ESD can be adequately adopted as an effective treatment for superficial adenocarcinomas at the EGJ.