Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2018; 24(35): 3965-3973
Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.3965
Role of endoscopic therapy in early esophageal cancer
Sonika Malik, Gautam Sharma, Madhusudhan R Sanaka, Prashanthi N Thota
Sonika Malik, Department of Internal Medicine, Cleveland Clinic Akron General Medical Center, Akron, OH 44307, United States
Gautam Sharma, Department of Anesthesiology, University Hospitals, Cleveland, OH 44106, United States
Madhusudhan R Sanaka, Prashanthi N Thota, Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, OH 44195, United States
Author contributions: All authors contributed to the conception and design, acquisition of data and drafting of manuscript; all authors approved the final version of the article, including the authorship list.
Conflict-of-interest statement: Authors deny any conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Prashanthi N Thota, MD, FACG, Medical Director, Esophageal Center, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. thotap@ccf.org
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: July 9, 2018
Peer-review started: July 9, 2018
First decision: July 17, 2018
Revised: July 23, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 21, 2018

Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.

Keywords: Endoscopic mucosal resection, Endoscopic submucosal dissection, Radiofrequency ablation, Argon plasma coagulation, Esophageal cancer, Photodynamic therapy, Cryotherapy

Core tip: Endoscopic eradication therapy (EET) plays a pivotal role in the management of patients with early esophageal cancer who are at very low risk for lymph node metastases. The main advantage of EET over surgery is the lower morbidity and mortality rates with similar cure rates, five-year survival rates and better quality of life. These excellent outcomes are tempered by the need for multiple treatment sessions for complete eradication and risk of post eradication recurrences. Careful patient selection by a multidisciplinary approach and patient compliance are crucial for treatment success.