Table 2.

Summary and Strength of Recommendations for Superficial Esophageal Squamous Cell Carcinoma

Statement E1: We recommend endoscopic resection for SESCC without distant or lymph node metastasis, excluding those with obvious submucosal invasion (Grade of recommendation: strong, Level of evidence: moderate).

Statement E2: We recommend Lugol chromoendoscopy and/or image-enhanced endoscopy to define the extent of lesion before endo- scopic treatment of SESCC (Grade of recommendation: strong, Level of evidence: moderate).

Statement E3: We recommend endoscopic ultrasound to define the stage of SESCC before endoscopic treatment (Grade of recommenda- tion: strong, Level of evidence: moderate).

Statement E4: We suggest magnifying endoscopy with narrow band imaging for SESCC to assess the depth of invasion before endoscopic treatment (Grade of recommendation: weak, Level of evidence: low).

Statement E5: We recommend endoscopic submucosal dissection rather than endoscopic mucosal resection for en bloc and curative re- section of SESCC confined to the mucosa (Grade of recommendation: strong, Level of evidence: moderate).

Statement E6: We recommend oral steroid or local steroid injection therapy for patients who develop mucosal defects in >75% of the esophageal circumference after endoscopic submucosal dissection to prevent esophageal stricture (Grade of recommendation: strong, Level of evidence: moderate).

Statement E7: No additional treatment is recommended after en bloc complete resection of SESCC invading no more than the lamina propria with no lymphovascular invasion because of a very low risk of lymph node metastasis (Grade of recommendation: strong, Level of evidence: moderate). As the risk of lymph node metastasis of a tumor invading into the muscularis mucosa without lymphovascular invasion is low, a close follow-up after en bloc complete endoscopic resection can be considered without additional treatment (Grade of recommendation: weak, Level of evidence: low). In case of a tumor with submucosal invasion, lymphovascular invasion, and/or positive vertical resection margin, additional treatment is recommended (Grade of recommendation: strong, Level of evidence: moderate).

SESCC, superficial esophageal squamous cell carcinoma.