Curative endoscopic submucosal dissection for esophageal squamous cell carcinoma after chemoradiotherapy for pharyngeal cancer: A case report

Figure 1 Endoscopic and macroscopic examination. A: Right lower pharyngeal cancer; B: Left middle pharyngeal cancer; C: Left hard palate cancer.

Figure 2 Endoscopic examination. A: White light endoscopy; B: Narrow band imaging (NBI) endoscopy; C: NBI endoscopy showed type B2 vessels in prominent elevated area; D: Endoscopic ultrasonography revealed submucosal layer thinning (the fifth layer) (UM-3R 20MHz). Esophageal cancer was observed at the upper thoracic esophagus (23 cm from the incisors).

Figure 3 Summary of the treatment timeline and clinical course of this case. EGD: Esophagogastroduodenoscopy; ESD: Endoscopic submucosal dissection.

Figure 4 Endoscopic examination (after undergoing chemoradiotherapy to the neck area). A: White light endoscopy; B: Narrow band imaging (NBI) endoscopy; C: NBI endoscopy showed type B1 vessels and small avascular area; D: Endocytoscopy showed complete loss of cellular structure with a significant increase in cellular density (EC classification: EC3). Esophagogastroduodenoscopy revealed the previously prominent elevated area had flattened and transformed into a 0-Ⅱb lesion.

Figure 5 Endoscopic submucosal dissection. A: Marking was performed around the lesion; B: No fibrosis was observed in the submucosal layer during endoscopic submucosal dissection; C: The lesion was completely resected without significant complications; D: Lugol's iodine staining of the lesion revealed to be removed en bloc; E: Pathological analysis revealed moderately differentiated squamous cell carcinoma and the invasion depth of the cancer was limited to lamina propria mucosa with negative vertical and horizontal margins, without lymphovascular invasion.