Endoscopic debulking resection with additive chemoradiotherapy: Optimal management of advanced inoperable esophageal squamous cell carcinoma

Figure 1 Technical notes of endoscopic debulking resection. This is a typical case from our study, A: An irregular, protruding neoplasm was seen in the esophagus 21 cm away from the incisor, occupying approximately 2/3 of the circumference of the lumen, and the endoscope could not pass through; B: Blue laser imaging magnification showed the type B2 intrapapillary capillary loop vessel in the lesion, with small aortic valve area observed; C: Endoscopic ultrasonography showed hypoechogenicity, an obvious thick mucosal layer and a submucosal layer. The submucosal layer of the lesion was discontinuous and involved the muscularis propria; D: A mixture of saline solution diluted with methylthionine chloride and epinephrine was injected into the lesion, and then incision of the lesion was made using the Dual-Knife; E: The final wound was hemostatically treated; F: A fully covered esophageal stent was finally implanted; G: One month later, the stent was removed endoscopically; H: After another week, the lumen of the endoscopic resection was slightly narrowed, but the ordinary gastroscope was still passable. A titanium clip was used to mark the lesion for later radiotherapy positioning; I: Six months of follow-up after chemoradiotherapy showed slight narrowing of the lumen of the esophagus.

Figure 2 The patient flow diagram. CRT: Chemoradiotherapy; EdR: Endoscopic debulking resection; ESCC: Esophageal squamous cell carcinoma.

Figure 3 The overall survival and progression-free survival of two groups. A: The cumulative overall survival of the endoscopic debulking resection (EdR) + chemoradiotherapy (CRT) and EdR groups; B: The cumulative progression-free survival of the EdR + CRT and EdR groups. CRT: Chemoradiotherapy; EdR: Endoscopic debulking resection; OS: Overall survival.