Current status of endoscopic submucosal tunnel dissection for treatment of superficial gastrointestinal neoplastic lesions

ABSTRACT

Introduction

With the widespread application of screening endoscopy and development of endoscopy-related instruments, more and more gastrointestinal cancers are detected in an early stage. Endoscopic resection is a preferred method for selected patients with superficial gastrointestinal neoplastic lesions, and endoscopic submucosal dissection (ESD) has become a standard method for its ability to perform en bloc resection regardless of the lesion size. ESD can be performed in a conventional or tunneling way, and the latter is termed endoscopic submucosal tunnel dissection (ESTD).

Area covered

In the present review, we provided a comprehensive review on ESTD for treatment of superficial gastrointestinal neoplastic lesions. We mainly focus on technical details, safety and efficacy of ESTD for esophageal, gastric and colorectal lesions. The present review is expected to provide tips for operators who are going to perform ESTD.

Expert opinion

The best indication of ESTD is large superficial esophageal neoplastic lesions (circumferential extent > 1/3 and longitudinal extent > 3 cm). Although ESTD has shown promising primary results for superficial gastric and colorectal neoplastic lesions, it is technically difficult and should be attempted only in experienced hands. Post-treatment stricture is a major concern, and preventive measures are recommended for patients with high risk of post-ESTD stricture.

KEYWORDS:

• Endoscopic submucosal tunnel dissection
• superficial esophageal cancer
• superficial gastric cancer
• superficial colorectal cancer
• postoperative stricture

Article highlights

• ESTD is a safe and effective method for treatment of large superficial esophageal neoplastic lesions (circumferential extent > 1/3 and longitudinal extent > 3 cm).

• ESTD can also be attempted for treatment of large superficial gastric or colorectal neoplastic lesions.

• ESTD is superior to conventional ESD in a higher dissection speed and curative resection rate.

• Circumferential extent of a mucosal defect > 3/4 and longitudinal extent > 3 cm are risk factors for post-ESTD esophageal stricture, while circumferential extent of a mucosal defect > 3/4 and longitudinal extent > 5 cm may be risk factors of post-ESTD gastric stricture.

• Local steroid injection and stent placement can be used to prevent post-ESTD stricture for patients with high risk. Other methods such as consecutive balloon dilation and autologous skin graft may also be attempted.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer is a consultant for Olympus, BSC, AbbVie, conned and Lumendi.

All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This study was funded by the Key Research Project of Hunan Province (2018SK21311).