Strategy for endoscopic submucosal dissection of carcinoma of the abdominal esophagus

A novel method of endoscopic submucosal dissection (ESD) has improved en bloc resection rates and decreased local recurrence after endoscopic therapy as compared with endoscopic mucosal resection (EMR), and resected ESD specimens allow accurate histopathological assessment. Although ESD has become popular for treating gastric neoplasms, esophageal ESD is more difficult than gastric ESD because of the anatomical characteristics of the esophagus. Thus, advanced endoscopic techniques are required. A good endoscopic field cannot always be obtained because the lumen of the abdominal esophagus is very narrow. Thus, the abdominal esophagus is one of the most technically difficult locations in which to implement ESD. Mucosal incision and submucosal dissection at the distal side of the lesion can be performed more easily at the anal side of the esophagogastric junction (EGJ) using the retroflex rather than the forward endoscopic view, and the endpoint of submucosal dissection can be defined. Longitudinal submucosal dissection of one side of the lesion from the proximal to the distal region is not necessary for an advanced scope and angle control. This strategy is useful when employing ESD to treat abdominal esophageal carcinoma.