Endoscopic management of early esophageal cancer: a literature review

Abstract

Objective: The purpose of this review is to familiarize the reader with endoscopic resection (ER) options for early-stage esophageal cancers. Background: Esophageal cancer consists of squamous cell carcinoma (SCC) and adenocarcinoma (EAC) and is associated with significant worldwide morbidity and mortality. People who are diagnosed after the development of symptoms, such as dysphagia, typically have more advanced tumor stages and poorer long-term outcomes. surgical esophagectomy is a historic gold standard curative treatment for patients with esophageal cancer. Endoscopic screening and surveillance in at-risk patients, such as those with Barrett’s esophagus, allows detection of esophageal cancer at an earlier stage. Recent developments in endoscopic techniques allow endoscopic removal of very early stage esophageal cancers, sparing some patients the need for esophagectomy, which harbors significant morbidity and mortality. Methods: An electronic search and data extraction of literature from inception was performed to present a narrative review on the endoscopic management of early esophageal cancer. Conclusions: The goal for curative surgical management of esophageal tumors is to achieve an R0 en bloc resection. The earliest stages of esophageal cancer (carcinoma-in-situ, moderately-to-well differentiated pT1a carcinomas without lymphatic or vascular invasion) of are now increasingly treated with ER techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). These effective resection techniques offer an additional curative treatment option for carefully selected patients. However, ER is only curative in patients without locoregional or distant metastatic disease. In this review we discuss the different approaches to endoscopic management of early esophageal cancer.