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Endoscopic submucosal dissection and potential cancer dissemination
  1. Kenneth K Wang
  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Kenneth K Wang, Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; wang.kenneth{at}

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The recent report from the highly regarded interventional endoscopy group in Hamburg suggests that endoscopic submucosal dissection (ESD) can lead to dissemination of oesophageal adenocarcinoma (Ehlken H et al, Gut 2021, PMID: 33441377). This study reported the rapid recurrence of two cases of submucosal Barrett’s oesophagus (BO)-related adenocarcinoma treated with near-circumferential and circumferential ESD. The cancers had extensive recurrence at the base of the resection penetrating into the muscularis propria and even more alarming lymph node metastasis. The authors sequenced the tumours to demonstrate that the recurrences were similar to the primary tumour. They then performed additional studies to demonstrate that the endoscope might be the cause of seeding. The authors found that there was opportunity for seeding to occur through contaminated endoscopic biopsy channels by demonstrating malignant cytology could be found in the biopsy channels of 5/5 patients biopsied with advanced cancers by forceps.

It should be noted that trying to culture biopsy samples from BO biopsies is quite difficult, and tumour implantation is not a trivial biological event to achieve. Downstream tumour implantation (ie, in the stomach or duodenum) from an ESD for oesophageal cancer has not been reported to our knowledge. Furthermore, steroids that had been used after ESD procedures to prevent strictures were identified as one mechanism to potentially aid recurrence as the addition of steroids to oesophageal adenocarcinoma line cultures induced proliferation.

Despite this evidence, the clinical literature does not support dissemination of …

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  • Contributors KKW wrote the commentary. Views reflect the opinions of the author.

  • Funding This work was partially funded from grants from the NIH U54 CA163004 and P01 CA084203.

  • Competing interests KKW received research funding from Fujinon Medical which does manufacture an ESD knife.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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