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Corresponding authors at: Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
Corresponding authors at: Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
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(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(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.
