Endoscopic Treatment in Esophagus Cancer: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection

Early (Superficial) esophageal cancers are classified as Tis (high-grade dysplasia [HGD] including non-invasive neoplastic epithelial neoplasms formerly called carcinoma in situ) or T1 tumors divided into T1a and T1b subcategories based on the depth of invasion. Endoscopic resection (ER) has alternative and several advantages over surgical resection, including; (1) Minimally invasive: ER avoids the need for surgery, resulting in reduced trauma, faster recovery, and fewer complications. (2) Preserves organ function: ER can be performed without removing the entire organ, which is particularly beneficial for lesions in organs like the gastrointestinal tract or respiratory system. (3) Reduced hospital stay: ER procedures are typically performed on an outpatient basis or require shorter hospital stays compared to surgical resection. The two main treatment options for early-stage esophageal cancer are esophagectomy and ER. An accurate assessment of the size of the tumor particularly the depth of invasion into the esophageal wall, is required to guide treatment. ER provides both diagnosis and treatment. ER is recommended instead of surgical resection in patients with limited mucosal lymphovascular invasion (LVI), patients with well-differentiated tumors, or elderly patients with high comorbidity. Mucosal ablative techniques such as radiofrequency ablation are increasingly important in treating ER. In previous literature, ER has been associated with successful outcomes in selected patients with long-term results. However, morbidities such as perforation, bleeding, and stricture development have been described after ER. This section will focus on the endoscopic diagnosis and treatment of superficial esophageal cancer.