Endoscopic Treatment of Early Esophageal and Gastric Cancer: A Case Study

By Amit Bhatt, MD

Cleveland Clinic’s team is among the highest volume centers in the country for the endoscopic treatment of early esophageal and gastric cancer. We have particular expertise in endoscopic submucosal dissection (ESD), a technique that allows us to endoscopically resect early esophageal and gastric cancers despite the size or scarring of a lesion, thereby avoiding a major abdominal or thoracic operation.

Our esophageal and gastric ESD outcomes are exemplary with a > 90 percent curative resection rate, without perforation or recurrence since start of our program.

Vignette

A 59-year-old female was diagnosed with a large 7 cm esophageal squamous cell cancer (SCC), involving more than two thirds of the circumference of the esophageal lumen during an upper endoscopy for acid reflux.

Due to her chronic obstructive pulmonary disease (COPD), she was told she was high risk for surgical resection, and palliative radiation and chemotherapy was recommended at an outside hospital.

The patient was referred to Cleveland Clinic for a second opinion. Following a multidisciplinary evaluation from our esophageal tumor board, she underwent ESD en-bloc resection of her tumor at our endoscopy suite.

Pathology revealed that despite the large size of the tumor, it was still a superficial T1a cancer, and the endoscopic resection was deemed a curative resection.

The patient recovered well from the procedure, is back to normal preoperative daily activities. She remains cancer-free to date with an excellent quality of life.

Lesion before treatment.

During ESD.

Immediately after ESD.

6 months after ESD resection of cancer.

The esophageal is well healed.

References

Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and Techniques for Endoscopic Submucosal Dissection. American Journal of Gastroenterology. 2015 Jun;110(6):784-91.

Bhatt, A, Abe S, Kumaravel A, Parsi MA, Stevens T, Jang S, Lopez R, Oda I, Vargo JJ, Saito Y. Video-based supervision for training of endoscopic submucosal dissection. Endoscopy. 2016 Aug;48(8):711-6.

Saito Y, Bhatt A, Nakajima T, Sakamoto T, Vargo J, Yamada M, Sekiguchi M, Takamaru H, Abe S, Nakanishi Y, Matsuda T. Colorectal endoscopic submucosal dissection (ESD) could reduce the need for surgery of colonic polyps in the West. Ann Laparosc Endosc Surg 2016 Oct;1:16.

Mortagy M, Mehta N, Parsi MA, Abe S, Stevens T, Vargo JJ, Saito Y, Bhatt A. Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures. World J Gastroenterol. 2017 Apr 28;23(16):2883-2890.

Saito Y, Bhatt A, Matsuda T. Colorectal endoscopic submucosal dissection and its journey to the West. Gastrointest Endosc. 2017 Jul;86(1):90-92.

Gorgun E, Benlice C. En Bloc Resection of a 5-cm Flat Ascending Colonic Lesion with Endoscopic Submucosal Dissection Combined with Laparoscopy. Dis Colon Rectum. 2016 Dec;59(12):1230​.