Endoscopic Submucosal Dissection in Esophageal Neoplasms

Endoscopic submucosal dissection (ESD) has transformed the management of superficial oesophageal neoplasms by enabling precise, en bloc removal of early malignant and premalignant lesions. Building on the limitations of endoscopic mucosal resection, ESD allows for wider excision margins and detailed histopathological assessment, offering high rates of curative resection while preserving organ function. Despite its clinical benefits, ESD carries risks of bleeding, perforation and postoperative strictures, particularly after extensive or circumferential resections. The technique demands advanced endoscopic skills and thorough knowledge of oesophageal wall anatomy, yet long-term data demonstrate excellent disease-specific survival and low recurrence when applied within established guideline criteria. Recent translational efforts have focused on reducing fibrotic complications through local therapies and regenerative approaches, underscoring the procedure’s global significance in minimising surgical morbidity and enhancing patient quality of life.

Research from Nature Portfolio

Recent studies have explored tissue engineering to prevent stricture after circumferential ESD. A landmark investigation assessed the feasibility of air-transported, autologous oral epithelial cell sheets for transplantation onto post-ESD ulcers. Patients undergoing complete or semicircular resections received endoscopic engraftment of these sheets, resulting in a reduced incidence of luminal narrowing and a marked decrease in dilation sessions. The transplanted cell sheets accelerated epithelial healing and demonstrated safety throughout preparation, transport and endoscopic application, establishing a proof of concept for regenerative cell therapy in oesophageal wound repair.

Endoscopic Submucosal Dissection in Esophageal Neoplasms publication trend

The graph below shows the total number of articles in endoscopic submucosal dissection in esophageal neoplasms across all publications each year (not limited to Nature Index journals).

Technical terms

Endoscopic submucosal dissection (ESD): Advanced endoscopic technique for en bloc removal of superficial gastrointestinal neoplasms by dissecting the submucosal layer.

Esophageal neoplasm: Abnormal tissue growth within the oesophagus, encompassing early-stage carcinoma and precursor lesions.

Esophageal stricture: Pathological narrowing of the oesophageal lumen, typically arising from fibrosis or scar formation following mucosal injury.

En bloc resection: Removal of a lesion in a single intact specimen to ensure complete histological evaluation.

Submucosa: Connective tissue layer beneath the mucosa containing blood vessels and lymphatics; the target plane for dissection in ESD.

References

1. MFGE8 in exosomes derived from mesenchymal stem cells prevents esophageal stricture after endoscopic submucosal dissection in pigs. Journal of Nanobiotechnology (2024).
2. Application of polyglycolic acid sheets and basic fibroblast growth factor to prevent esophageal stricture after endoscopic submucosal dissection in pigs. Journal of Gastroenterology (2023).
3. Endoscopically injectable and self‐crosslinkable hydrogel‐mediated stem cell transplantation for alleviating esophageal stricture after endoscopic submucosal dissection. Bioengineering & Translational Medicine (2023).
4. Oral epithelial cell sheets engraftment for esophageal strictures after endoscopic submucosal dissection of squamous cell carcinoma and airplane transportation. Scientific Reports (2017).
5. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surgical Endoscopy (2012).
6. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterology (2011).