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Endoscopic submucosal dissection (ESD) is an accepted treatment for early esophageal cancer. However, for large early esophageal cancers, ESD is associated with an increased riskof stricture development. A 73-year-old man was diagnosed with esophageal cancer (cT1N1M0, stage IIb). He received concurrent chemoradiotherapy (CCRT), including four cycles of monthly fluorouracil, cisplatin, and radiation (54Gy). At 96 months after CCRT, he had multiple Lugol-unstained lesions, 22–32cm from the upper incisor (●" Fig.1). The pathological results indicated well-differentiated squamous cell carcinoma at 22cm and 25cm from the upper incisor, and squamous epithelial dysplasias at 25–32cm from the upper incisor. We performed ESD (22–32cm from the upper incisor, representing over 90% of the esophageal circumference) (●" Fig.2a). Successful en bloc resection was achieved without adverse events (●" Fig.2b). On the day after ESD, in order to prevent stricture development, a 100×50mm polyglycolic acid (PGA) sheet (Neoveil; Gunze Co., Kyoto, Japan) was placed with hemoclips, followed by application of a fibrin glue (Beriplast P Combi-set; CSL Behring Pharma, Tokyo, Japan) (●" Fig.3, ●" Video 1). Fig.2 Endoscopic submucosal dissection of the esophageal lesions. a Approximately 90% of the circumference of the esophagus was removed. b The resected specimen. Fig.1 Endoscopic view showing multiple Lugol-unstained lesions, 22–32cm from the upper incisor, 96 months after concurrent chemoradiotherapy for esophageal cancer.

Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for recurrent esophageal cancer