Underwater endoscopic submucosal dissection performed under general anesthesia for the safe resection of superficial esophageal squamous cell carcinoma with ductal involvement

A superficial esophageal squamous cell carcinoma (ESCC) will sometimes extend into the ducts of the submucosal esophageal glands (SEGs), so-called "ductal involvement," with the frequency of this reported to be 21.3%–37.1% [1] [2]. SEGs are generally ignored during an endoscopic submucosal dissection (ESD) procedure, although they should be considered because of the potential of ductal involvement. For digestive tumor cases, underwater endoscopic submucosal dissection (UESD) procedures can reportedly assist with the submucosal approach by raising the mucosa through buoyancy [3]; however, this is not usually applied for superficial ESCC cases owing to the severe risk of aspiration. The results presented of UESD for superficial ESCCs with ductal involvement being performed with the patient under general anesthesia indicate good safety and a high level of resectability.