Observational analysis shows effective resection of ESCC using water pressure method in patients with fibrosis, indicating a solution for challenging repeat procedures.
Endoscopic submucosal dissection (ESD) is a standard treatment for superficial esophageal squamous cell carcinoma (ESCC). Metachronous ESCC sometimes occurs close to the previous ESD scars, and a repeat ESD becomes difficult due to the high risk of perforation [1]. A previous ESD can cause severe fibrosis in the submucosal layer, making it difficult to identify the appropriate dissection layer and successfully perform a repeat ESD. Recently, a water pressure method (WPM), which facilitates easy access to the mucosal flap, was developed [2] [3], and some reports have shown that it can help with ESD in patients with severe fibrosis [4] [5]. Herein, we present a case in which WPM helped perform an en bloc resection of ESCC, located at a site overlapping a previous ESD scar, without perforation ([Video 1]).
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Shiotsuki et al. (2025) studied this question.