Esophageal endoscopic submucosal dissection using a novel thin therapeutic scope for early esophageal cancer adjacent to chemoradiotherapy-induced stricture

Metachronous esophageal cancers frequently occur, but endoscopic submucosal dissection (ESD) for lesions that occur adjacent to post-treatment scars are often challenging. Furthermore, in cases involving post-treatment stricture, endoscopic balloon dilation or scar incision may be required before ESD, so synchronous ESD for such lesions are even more challenging. Recently, a novel therapeutic thin endoscope, the EG-840TP (Fujifilm, Tokyo, Japan), has been developed. This scope has a thinner outer diameter (7.9 mm) and more adequate down angle (160°) than a conventional therapeutic scope ( Fig. 1, Fig. 2 ). We report a very successful case of ESD using this scope for a superficial esophageal cancer adjacent to a chemoradiotherapy-induced stricture ( Video 1 ).

Fig. 1.

 Comparison of outer diameter of the novel scope and the conventional treatment scope. The novel scope has a thinner outer diameter of 7.9 mm, whereas the conventional therapeutic scope has an outer diameter of 9.8 mm.

Fig. 2.

 Comparison of down angle of the novel scope and the conventional treatment scope. The novel scope has a more adequate down angle of 160°, whereas the conventional therapeutic scope has down angle of 120°.

Video 1  Esophageal endoscopic submucosal dissection using a novel thin therapeutic scope for early esophageal cancer adjacent to chemoradiotherapy-induced stricture.

Download video file ^{(63MB, mp4)}

The patient was a 75-year-old woman who underwent chemoradiotherapy for early esophageal cancer 11 years previously. A new lesion was detected adjacent to the chemoradiotherapy-induced stricture ( Fig. 3 ). However, a conventional therapeutic scope could not pass the stricture, making it very challenging to perform synchronous ESD. Given this situation, we decided to perform ESD using the novel thin scope.

Fig. 3.

 White-light and narrow-band imaging of the lesion and stricture. A new lesion (arrows) was detected adjacent to the chemoradiotherapy-induced stricture.

Iodine staining confirmed that the lesion did not extend substantially to the anal side of the stricture. The scope enabled us to make the markings and mucosal incision on the anal side of the lesion beyond the stricture ( Fig. 4 ). The scope was only just able to pass through the stricture for mucosal incision on the anal side of the lesion. Thereafter, although severe fibrosis was observed, resection using the water pressure method was achieved en bloc without adverse events ( Fig. 5 ) ¹ .

Fig. 4.

 White-light imaging of the lesion marking beyond the stricture. The novel scope enabled us to make the markings beyond the stricture.

Fig. 5.

 White-light imaging of the specimen with iodine staining. R0 resection was successfully achieved.

Use of this novel thin scope may allow synchronous endoscopic treatment for challenging cases that would normally require prior treatment for stricture. This scope will contribute to the further development of endoscopic treatment.

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Endoscopy E-Videos : https://eref.thieme.de/e-videos .

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply, discounts and wavers acc. to HINARI are available. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos