Pedunculated esophageal carcinoma endoscopically removed using SB knife Jr with detachable snare after neoadjuvant chemo
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CASE REPORT
Pedunculated esophageal carcinoma endoscopically removed using SB knife Jr with detachable snare after neoadjuvant chemotherapy Nobutoshi Hagiwara1 · Takeshi Matsutani1,2 · Takahiro Haruna1 · Tsutomu Nomura1 · Hiroshi Yoshida1 Received: 5 May 2020 / Accepted: 16 August 2020 © Japanese Society of Gastroenterology 2020
Abstract An 82-year-old Japanese man with alcoholic liver cirrhosis was referred to our hospital for treatment of advanced esophageal cancer. A protruding tumor was endoscopically observed in the middle thoracic esophagus, and pathological findings of the biopsy specimens revealed a squamous cell carcinoma. The clinical tumor staging was stage II (T3N0M0). The patient received two courses of neoadjuvant chemotherapy with 5-fluorouracil and nedaplatin. After the treatments, computed tomography showed significant reductions in the size of the target tumor. However, radical esophagectomy was not performed because the patient refused major invasive treatments. Instead, endoscopic resection was performed using a combination of polypectomy and endoscopic submucosal resection (ESD). To prevent bleeding during endoscopic treatment, we applied a detachable snare to the base of the tumor and cut the stalk using by an SB knife Jr, without hemorrhage. The pathohistology of the resected specimen was positively showed cancer cells on the margin of the esophageal carcinoma stalk. At 4 weeks after the initial operation, an additional ESD was successfully performed, which pathologically led to radical removal. The patient survived for more than 18 months after beginning the initial treatment. We describe a successful treatment using endoscopic resection after chemotherapy for advanced esophageal cancer with high surgical treatment risks. Keywords Esophageal cancer · Endoscopic resection · SB knife Jr · Detachable snare · Chemotherapy
Introduction Despite recent advances in techniques and intensive care management in the surgical treatment for esophageal cancer, patients with liver cirrhosis still have a greater perioperative risk of morbidity and mortality [1, 2]. The management of these patients is challenging and requires a multimodal approach. Recently, the frequency of application of neoadjuvant treatment has increased in patients with gastrointestinal tract malignancies. As the result of the Japan Clinical Oncology Group 9907 clinical trial study, neoadjuvant chemotherapy has improved survival and become the standard therapy for patients with advanced esophageal squamous cell carcinoma [3]. However, there have been few reports of endoscopic removal as an effective treatment after * Nobutoshi Hagiwara [email protected] 1
Department of Gastrointestinal Hepato‑Biliary‑Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
2
neoadjuvant treatment of these patients [4–6]. Even when radical surgical treatment (esophagectomy with therapeutic lymphadenectomy) is impossible in some patients due to their ge
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