Utility of endoscopic submucosal dissection in T1b esophageal cancer

At this time on the basis of a systematic review of the literature, we believe that endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) can be successfully applied to submucosal invasive cancers that have a low risk of metastatic potential. Overall, the risk of metastasis is higher in submucosal squamous cell carcinoma (SCC) in comparison with that of submucosal adenocarcinoma. Staging of these tumors should be conducted with endoscopic ultrasound (EUS), although the accuracy of EUS in discerning the depth of invasion is limited. Additional treatment should be determined by factors such as tumor grade, status of lymphovascular invasion, and depth of tumor, which have a direct influence on metastatic potential. In those patients with submucosal invasion and risk factors, adjuvant chemotherapy and radiation may mitigate metastatic potential. Future research should focus on novel biological and immunohistochemistry markers that can aid in the prediction of tumor behavior and lymph node metastasis (LNM) in T1b esophageal cancer.