EARLY ESOPHAGEAL CANCER AT A MIDDLE ESOPHAGEAL DIVERTICULUM TREATED BY ESD: A CASE REPORT AND LITERATURE REVIEW

Abstract

A 65-year-old male with esophageal cancer in an esophageal diverticulum (ED) was referred to our department for detailed examination and treatment. EUS showed an ED located 28 cm from the incisor teeth and a muscular layer in the diverticulum wall without apparent defects. Early-stage symptoms of the disease were observed at the site of the cancer lesion. CT showed a middle ED caused by traction. Considering the risk of perforation, we performed ESD using a transparent hood, traction method, and CO₂ air delivery under general anesthesia. En bloc resection was performed, and the duration of surgery was 69 min. CT on the following day showed no leakage. The patient was discharged without complications. Based on a literature review, we report that cases of ESD for esophageal cancer in an ED generally demonstrate favorable outcomes, similar to the present case. However, the styles of pre-therapeutic assessment and intra-operative management were inconsistent among the cases. Evaluation of the presence of muscularis propria using EUS, confirmation of the positional relationship with surrounding organs on CT, pre-therapeutic assessment of physical function, general anesthesia or preparation for a shift to general anesthesia, and availability of surgical repair in cases of esophageal rupture are required when performing ESD for lesions in an ED.