Indications for endoscopic treatment of adenocarcinoma and squamous cell cancer of the esophagus

: Endoscopic treatment of esophageal adenocarcinoma (EAC) and squamous cell cancer (ESCC) has gained importance over the last years. Early endoscopic detection has important prognostic and therapeutic implications because of the risk of lymph node metastasis even in early stages of disease. Endoscopic image enhancement techniques and virtual chromoendoscopy are helpful diagnostic tools for the detection of early neoplastic lesions. The characterization of mucosal and vascular pattern by using magnifying endoscopy and narrow band imaging (NBI) and embedding this information in classifications are useful in assessing neoplastic lesions and their invasion depth. For example, the Japanese Esophageal Society (JES) classification applies NBI in the evaluation and assessment of esophageal cancer. Both EAC and ESCC should be treated by en bloc resection whenever possible. Because of the higher risk of lymph node metastasis early ESCC should be treated endoscopically only up to a mucosal invasion depth of m2. Submucosal invasion especially deeper than 200 µm has a significant risk of lymph node metastasis. Endoscopic mucosal resection (EMR) should be performed if the lesion is smaller than 15 mm otherwise endoscopic submucosal dissection (ESD) is recommended. In early adenocarcinoma, these criteria can be extended if submucosal invasion is less than ≤ 500 µm (sm1) and the resected carcinoma is well or moderately differentiated, with a lesion size <3 cm and without lymphatic invasion. For early EAC larger than 15 mm, lesions suspicious for submucosal invasion or lesions with poor lifting, ESD is recommended. For well or moderately differentiated early squamous cell carcinoma (SCC) and early adenocarcinoma of the esophagus, curative resection is achieved if there is no lymphatic or vascular invasion. After endoscopic resection, additional endoscopic treatment options exist for example local ablative procedures such as radiofrequency ablation (RFA) for residual Barrett segments. 8