Clinical outcomes of circumferential endoscopic submucosal dissection in esophageal squamous cell carcinoma > 50 mm: Retrospective cohort study

Abstract

Background and study aims

This study aimed to assess both short-term safety and long-term outcomes of whole circumferential endoscopic submucosal dissection (WC-ESD) for esophageal squamous cell carcinoma (ESCC) with tumor length > 50 mm, and to evaluate effectiveness of aggressive prophylactic dilation combined with steroid therapy in preventing esophageal stricture.

Patients and methods

A retrospective review was conducted on 67 patients who underwent WC-ESD for superficial ESCC between 2009 and 2019 at a single Japanese center. Patients were categorized into > 50-mm and ≤ 50-mm groups. The primary endpoint was incidence of post-ESD stricture in the main analysis excluding surgery/chemoradiotherapy cases within 90 days; sensitivity analysis included all patients. Secondary endpoints were number of dilations, steroid use, and long-term survival outcomes (overall survival [OS], disease-specific survival [DSS], relapse-free survival [RFS]).

Results

Stricture incidence was not significantly different (> 50 mm vs. ≤ 50 mm: 13% vs. 18%, P = 0.708; sensitivity: 21% vs. 15%, P = 0.538). Although dilations were more frequent in the > 50-mm group (96% vs. 83%), median sessions were similar (8 vs. 7.5). Prophylactic dilation plus steroids reduced refractory strictures (25%→7%, P = 0.03). For pT1a-EP/LPM cases, 5-year OS, DSS, and RFS were 100% in both groups. In pT1a-MM/pT1b cases, survival was comparable, although OS tended to be lower with > 50-mm lesions (68.9% vs. 100%, P = 0.07).

Conclusions

WC-ESD for superficial ESCC with a tumor length > 50 mm did not increase adverse events and provided comparable long-term survival. These findings support feasibility beyond guideline limits and emphasize further refinement of stricture prevention.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Dilation, injection, stenting - Barrett's and adenocarcinoma

Publication History

Received: 16 February 2025

Accepted after revision: 21 October 2025

Accepted Manuscript online:
01 December 2025

Article published online:
19 December 2025

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