When Is Pre-Emptive Treatment Necessary after Endoscopic Mucosal Resection of Early Esophageal Neoplasm?

treatment of choice and an alternative to esophagectomy in the treatment of Barrett’s esophagus with early neoplasia and superficial esophageal cancer limited to the mucosal layer.1 EMR of larger lesions requires piecemeal resection which allows the risk of higher local recurrence than in cases with en bloc resection. Endoscopic submucosal dissection (ESD) has been successfully applied for the treatment of early esophageal cancer including squamous cell carcinoma and Barrett’s adenocarcinoma (BA).2 Esophageal strictures are among the most common and problematic complications of EMR and endoscopic ablation therapy in early esophageal neoplasm and the leading cause of long-term morbidity.3-6 Symptomatic stricture formation has been reported after the use of EMR, photodynamic therapy, and combination therapy in 13% to 50% of patients.3-6 Esophageal strictures often require multiple dilations to resolve dysphagia; however, risk factors for esophageal stricture and dysphagia have not been clearly defined. Their determination would make it possible to identify those patients who may benefit from early pre-emptive intervention such as prophylactic dilation.7 In an early study, Katada et al.8 reported that resection of >75% of the esophageal circumference was associated with a high rate of stricture formation in patients with superficial esophageal squamous cell carcinoma (SESCC) and that mucosal defects longer than 30 mm were associated with greater