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September 10, 2025

The Multi-Center Retrospective Study on Surveillance Endoscopy After Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma

Puntos clave

Annual surveillance endoscopy effectively detected early-stage esophageal squamous cell carcinoma after resection.
The study found a three-year cumulative incidence of 1.1% for Index ESCC-1 and 0.27% for Index ESCC-2.
Using NBI with iodine staining proved crucial, as all Index ESCC-2 cases were found in this group.
The findings indicate that current surveillance endoscopy methods are suitable post-endoscopic resection for ESCC.

Resumen

Abstract Background Various methods of postoperative surveillance endoscopy are employed for patients with esophageal squamous cell carcinoma (ESCC) who have undergone endoscopic resection (ER). However, the accuracy of these methods has not been thoroughly evaluated. This study aimed to assess the effectiveness of current surveillance endoscopy methods. Methods This multicenter retrospective study analyzed 394 cases of endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC) from 2014 to 2016. Patients who required no additional treatment and underwent at least two years of surveillance endoscopy were included. The primary outcome was the three-year cumulative incidence of ESCC recurrence, classified as Index ESCC-1 (pT1a-MM or deeper, or with lymphovascular invasion) and Index ESCC-2 (pT1b-SM or deeper, or with lymphovascular invasion). Surveillance intervals were categorized as every six months, every twelve months, or irregular, and endoscopic modalities included NBI alone, NBI with iodine staining, or both alternately. Results The cohort included 91% males, with a median age of 68 years. The median follow-up was 67.4 months. Surveillance was conducted every six months in 192 patients, every twelve months in 137, and irregularly in 65. Two patients underwent NBI alone, 364 had NBI with iodine staining, and 14 alternated between both. During surveillance, 165 patients developed multiple ESCCs (313 lesions) with 3.5% as Index ESCC-1, and 0.96% as Index ESCC-2. All Index ESCC-2 were detected in the NBI plus iodine group. The three-year cumulative incidences were 1.1% for Index ESCC-1 and 0.27% for ESCC-2. No ESCC-related deaths occurred. Conclusion For patients with ESCC who underwent ER followed by surveillance, performing surveillance endoscopy at least once a year was sufficient to detect multiple ESCC at an early-stage. These findings suggest that the currently employed surveillance endoscopy methods are appropriate.

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