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Corrosive induced early carcinoma of esophagus after 55 Years: Resection by endoscopic submucosal dissection

  • Author Footnotes
    1 Tao Wang and Lanping Zhu contributed equally to this work and were the co-first authors.
    Tao Wang
    Footnotes
    1 Tao Wang and Lanping Zhu contributed equally to this work and were the co-first authors.
    Affiliations
    Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
    Search for articles by this author
  • Author Footnotes
    1 Tao Wang and Lanping Zhu contributed equally to this work and were the co-first authors.
    Lanping Zhu
    Footnotes
    1 Tao Wang and Lanping Zhu contributed equally to this work and were the co-first authors.
    Affiliations
    Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
    Search for articles by this author
  • Xin Chen
    Correspondence
    Corresponding authors at: Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
    Affiliations
    Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
    Search for articles by this author
  • Bangmao Wang
    Correspondence
    Corresponding authors at: Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
    Affiliations
    Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
    Search for articles by this author
  • Author Footnotes
    1 Tao Wang and Lanping Zhu contributed equally to this work and were the co-first authors.
Published:January 14, 2023DOI:https://doi.org/10.1016/j.dld.2022.12.020
      A 59-year-old man developed dysphagia following ingestion of caustic soda 55 years ago. Recently, he presented with worsening dysphagia for 3 months. Ultrafine gastroscopy showed that the esophagus had multisegmental cicatricial stricture, and the circumferential mucosa was rough at 34–37 cm from the incisors (Fig. 1a). Biopsy revealed high-grade intraepithelial neoplasia of squamous epithelium with suspicious infiltration (Fig. 1b). Endoscopic ultrasonography (Fig. 1c) and imaging demonstrated no metastasis. The patient eventually underwent endoscopic submucosal dissection (ESD). During the procedure, radial incision was first performed to release esophageal stenosis, and then the lesion was circumferentially excised from the oral side to the anal side in a I-shaped way, and finally the lesion was completely removed (Fig. 1d-h). Histopathology revealed well to moderately differentiated esophageal squamous cell carcinoma, with tumor invasion into the superficial layer of muscularis mucosae (stage T1a-M3), and the resection margins were clear of tumor involvement (Fig. 2a). After operation, he received self-help inflatable balloon to prevent esophageal stenosis (Fig. 2b). Fourteen months postoperatively, he remained well, with no obvious esophageal stenosis (Fig. 2c), tumor recurrence or metastasis.
      Fig 1
      Fig. 1(a) Endoscopic image of esophageal stricture and the circumferential mucosa. (b) Biopsy from the lesion revealed high-grade intraepithelial neoplasia of squamous epithelium (HE stain, × 200). (c) Endoscopic ultrasonography showed no deep tumor invasion. (d-h) Procedure of endoscopic submucosal dissection.
      Fig 2
      Fig. 2(a) Histopathology revealed well to moderately differentiated esophageal squamous cell carcinoma (HE stain, scale bar = 125 μm). (b) The use of self-help inflatable balloon to prevent esophageal stenosis. (c) Postoperative follow-up showed no obvious esophageal stenosis.

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      References

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        • Tercioti Jr, V.
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        • et al.
        Caustic stenosis of the esophagus and malignant neoplasia: a dilemma.
        Front Oncol. 2022; 121059524