Clin Endosc.  2024 Sep;57(5):559-570. 10.5946/ce.2023.263.

Surveillance for metachronous cancers after endoscopic resection of esophageal squamous cell carcinoma

• Ishihara R

• KMID: 2559204
• DOI: http://doi.org/10.5946/ce.2023.263

Abstract

The literature pertaining to surveillance following treatment for esophageal squamous cell carcinoma (SCC) was reviewed and summarized, encompassing the current status and future perspectives. Analysis of the standardized mortality and incidence ratios for these cancers indicates an elevated risk of cancer in the oral cavity, pharynx, larynx, and lungs among patients with esophageal SCC compared to the general population. To enhance the efficacy of surveillance for these metachronous cancers, risk stratification is needed. Various factors, including multiple Lugol-voiding lesions, multiple foci of dilated vascular areas, young age, and high mean corpuscular volume, have been identified as predictors of metachronous SCCs. Current practice involves stratifying the risk of metachronous esophageal and head/neck SCCs based on the presence of multiple Lugol-voiding lesions. Endoscopic surveillance, scheduled 6–12 months post-endoscopic resection, has demonstrated effectiveness, with over 90% of metachronous esophageal SCCs treatable through minimally invasive modalities. Narrow-band imaging emerges as the preferred surveillance method for esophageal and head/neck SCC based on comparative studies of various imaging techniques. Innovative approaches, such as artificial intelligence-assisted detection systems and radiofrequency ablation of high-risk background mucosa, may improve outcomes in patients following endoscopic resection.

Keyword

Endoscopic resection; Esophageal squamous cell carcinoma; Metachronous cancers; Surveillance

Figure

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  Fig. 1. Grade C Lugol-voiding lesions, defined as ≥10 lesions per endoscopic view.

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  Fig. 2. Foci of dilated vessels (arrows).

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  Fig. 3. Surveillance protocol for the head/neck region and the esophagus. GI, gastrointestinal; NBI, narrow-band imaging; BLI, blue laser imaging.

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  Fig. 4. Metachronous cancer of the tongue (arrows) detected by gastrointestinal endoscopic examination.

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  Fig. 5. Metachronous cancer of the buccal mucosa (arrow) detected by gastrointestinal endoscopic examination.

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  Fig. 6. Metachronous cancer of the soft palate (arrow) detected by gastrointestinal endoscopic examination.

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  Fig. 7. Metachronous cancer of the hypopharynx (arrows, post-cricoid area) detected by gastrointestinal endoscopic examination using the Valsalva maneuver. This maneuver entails a forceful attempt to exhale against a closed airway and can be used to observe the post-cricoid area.

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  Fig. 8. Observation of the tongue (A), the oropharynx (B), and the post-cricoid area and posterior wall (C).

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