120. PRE-ENDOSCOPIC DILATION AND OUTCOMES IN PATIENTS WITH METACHRONOUS RECURRENT ESOPHAGEAL CANCERLOCALIZED ON THE DISTAL SIDE OF ESOPHAGEAL STRICTURE

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Abstract Background For superficial esophageal cancer, cT1a-EP/LPM lesions are indicated for endoscopic submucosal dissection (ESD) regardless of circumferential involvement. And advancements in drug therapy and effective management have improved the long-term prognosis of advanced head and neck cancer and esophageal cancer. However, in patients with metachronous recurrent esophageal cancers discovered after treatment, achieving stricture release before initiating treatment is often challenging. This study aimed to investigate an appropriate dilation method for esophageal cancer with stricture and evaluate suitable treatment methods after dilation. Methods We analyzed 106 lesions of superficial esophageal squamous cell carcinoma with stricture in patients treated from 2004 to 2024. Stricture was defined as inability to pass a therapeutic endoscope (≥12 mm). Patients were divided into three groups based on the release method: endoscopic balloon dilation (EBD) (83 lesions), radial incision and cutting (RIC) (6 lesions), and non-dilation (17 lesions). Post-dilation treatments were analyzed in the argon plasma coagulation (APC) (43 lesions) and endoscopic resection (ER) groups (63 lesions). Key parameters included stricture characteristics, dilation outcomes, and treatment success, focusing on en bloc resection, curative resection, and recurrence. Results The primary stricture cause was postoperative anastomotic stricture in the EBD (51.5%) and non-dilation (52.9%) groups, while it was post-ER stricture in the RIC group. The average number of dilations was 1.2 and 1 in the EBD and RIC groups, respectively, with dilation sites averaging 1.3 and 1, respectively. A post-dilation maximum diameter of ≥12 mm was achieved in 65.1% of EBD and 100% of RIC cases. One esophageal perforation occurred in the EBD group. The en bloc and curative resection rates after ER were 98.4% and 84.1%, respectively, with no recurrences, compared to a 37.2% recurrence rate after APC. Conclusion EBD and RIC are effective methods for managing stricture release; however, EBD requires caution to avoid adverse events. Given the high recurrence rate after APC treatment, en bloc resection with ESD, after careful dilatation, is recommended.

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