Management of Esophageal Squamous Cell Neoplasia

Purpose of review This article reviews the most recent advances regarding the diagnosis and endoscopic treatment of superficial esophageal squamous cell neoplasia. Recent findings The incidence of superficial esophageal squamous cell carcinoma (ESCC) has increased mainly because of improvement in endoscopic detection. It is estimated that high-definition white light endoscopy has low sensitivity for the detection of ESCC. Lugol’s iodine chromoendoscopy significantly improves the diagnosis, but with a low specificity. Recently, magnifying endoscopic assessment of the intrapapillary capillary loops has been shown to accurately predict the depth of invasion and therefore guide the best treatment choice. Consequently, management of neoplasms of the esophagus has changed in recent years as endoscopic resection techniques have gradually become more important. Summary For superficial ESCC, endoscopic submucosal dissection is considered the preferred approach, enabling accurate en bloc resection with a lower recurrence rate and improved survival. Although some studies have shown promising results for endoscopic resection of submucosal tumors, there are limitations and surgery continues to be the standard treatment for more advanced lesions, either alone or in combination with chemoradiotherapy.