Knife-assisted endoscopic full-thickness resection of deeply invasive esophageal adenocarcinoma: a case series

Abstract

Background and Aims

Esophageal adenocarcinoma (EAC) incidence is rising globally, and current therapeutic options carry substantial morbidity and mortality. We report the feasibility and early outcomes of knife-assisted endoscopic full-thickness resection (kFTR) as a palliative local control in nonsurgical candidates.

Methods

Three patients with suspected locally advanced distal EAC (clinical tumor stage T1b-T2), no nodal or distant disease, and high Charlson Comorbidity Index scores were unfit for surgery and declined chemoradiotherapy. All consented to kFTR: a submucosal pocket was created cranial to the suspected invasive area, the muscle-retracting sign was identified, and the muscularis propria was incised to access the periesophageal space. The lesion was dissected laterally and resected en bloc. A fully covered metal stent was then placed.

Results

Patients resumed oral intake on day 5 without major adverse events. All had EAC pathologic tumor stage 1b with invasion into the deepest layer of the submucosa; 2 had positive vertical margins. One remained disease-free (24 months); 2 had local recurrence by 6 months but remained asymptomatic at last follow-up (10 and 14 months).

Conclusions

In carefully selected symptomatic, inoperable patients, kFTR achieved short-to-medium term symptom control for locally advanced EAC with acceptable safety.