Endoscopic Resection and Ablation in Esophageal Cancer Endoscopic resection (ER) should be accepted as the treatment of choice in most patients with high-grade intraepithelial neoplasia and mucosal carcinoma in the esophagus. Several series have reported excellent acute results with ER for squamous cell carcinoma and Barrett’s adenocarcinoma in comparison with esophageal resection, which in the USA is associated with a 30-day mortality rate between 8.4% in large-volume centers and up to 20.3% in centers with low experience. However, there are no prospective studies comparing ER and surgery to make final conclusions on this issue. With regard to the long-term outcome, one large series in early Barrett’s cancer and three in patients with squamous cell carcinoma have been published. A close followup program is crucial for surveillance of the residual Barrett’s esophagus. To improve the acceptance of endoscopic treatment, further prospective trials with long-term data are necessary. To obtain resection specimens that are large enough, ER in the esophagus should only be carried out using the suck-and-cut technique, either with the cap or the ligation device. Endoscopic submucosal dissection appears to be an attractive new treatment method not only for early gastric cancer but also for patients with early esophageal malignancy. This method is able to provide complete en bloc resection of larger neoplastic lesions, but experience is so far very limited, and the complication rate is relatively high in comparison with conventional ER. The same requirements in terms of hospital volume that are made for surgeons should also be made for endoscopists diagnosing and treating patients with early esophageal cancers, and a special level of experience should be mandatory.

Keywords:
Endoscopic resection, Endoscopic ablation, Early esophageal cancer
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© 2008 S. Karger AG, Basel
2008
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