Endoscopy 2006; 38(2): 170-174
DOI: 10.1055/s-2005-921039
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Safety of Endoscopic Submucosal Dissection for Tumors of the Esophagogastric Junction

N.  Kakushima1 , N.  Yahagi1 , M.  Fujishiro1 , S.  Kodashima1 , M.  Nakamura1 , M.  Omata1
  • 1Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
Further Information

Publication History

Submitted 7 April 2005

Accepted after revision 21 July 2005

Publication Date:
14 February 2006 (online)

Background and Study Aims: The esophagogastric junction (EGJ) has been considered a difficult location for endoscopic treatment of tumors, due to its narrow lumen and sharp angle. Endoscopic submucosal dissection (ESD) is a method of endoscopic resection, capable of removing large tumors in an en bloc fashion. The aim of this study was to evaluate the efficacy and safety of ESD for EGJ tumors.
Patients and Methods: For 30 lesions of EGJ tumors treated by ESD, the size of the lesions and resected specimens, the en bloc resection rate, complications, and local recurrence were assessed.
Results: The average maximum diameters of the lesions and resected specimens were 22.4 mm and 40.6 mm respectively. The complete en bloc resection (R0) rate was 97 % (29/30). Histological evaluation of the resected specimens revealed five cases of angiolymphatic invasion and five cases of submucosal invasion deeper than 500 μm. Perforation occurred in one case but was safely managed by rotatable clips and administration of antibiotics for 3 days. Local recurrence was not observed in any patient during follow-up (mean 14.6 months, range 6 - 31 months).
Conclusions: ESD can be safely performed for EGJ tumors, with a high en bloc resection rate. For lesions with no apparent submucosal invasion findings, ESD is a curative and diagnostic treatment option that may be considered before open surgery.

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M. Fujishiro, M. D. Ph. D.

Department of Gastroenterology

Faculty of Medicine · The University of Tokyo · 7-3-1, Hongo · Bunkyoku · Tokyo · 113-8655 Japan

Fax: +81-3-58008806

Email: mtfujish-kkr@umin.ac.jp