Outcomes of endoscopic submucosal dissection in esophageal adenocarcinoma staged T1bN0 by endoscopic ultrasound in non-surgical patients.

Patients with esophageal adenocarcinoma (EAC) invading submucosa (T1b) are traditionally treated with esophagectomy and with chemoradiotherapy in poor surgical patients. Endoscopic submucosal dissection (ESD) has emerged as an alternative treatment in these patients. In this case series, we analyzed the outcomes of ESD in EAC staged T1bN0 by endoscopic ultrasound (EUS). Patients with EAC staged T1bN0M0 by EUS and PET scan who underwent ESD by a single operator (MS) between 2014 and 2017 at our institution were included. They were deemed as poor surgical candidates and ESD was considered as the most appropriate treatment option after a multi-disciplinary evaluation. There were 8 patients (male =5; female =3) with average age of 70.5 years old (range, 53-84 years old). ESD was completed in 7 and aborted in 1 patient due to tumor invasion into muscularis propria. En bloc , R0 and curative resection rates were 86% (6/7), 86% (6/7) and 71% (5/7) respectively. Final histology was intramucosal (T1a) in 4 and submucosal (T1b) in 3. One patient (14%) developed stricture requiring balloon dilation. Mean follow-up duration was 10 months (range, 3-15 months) and 71% (5/7) remain in clinical remission. Two patients required CRT, one with T1a who developed recurrence and another with T1b with lymphovascular invasion. In poor surgical candidates, ESD was associated with accurate staging and favorable outcomes in EAC staged T1bN0 by EUS. We suggest considering ESD in EAC staged T1bN0 for accurate histological staging, curative potential and also to help determine further course of treatment.