Endoscopic Treatment of Early Esophageal and Gastric Cancer: A Case Study

Offers cure instead of palliation, avoids major surgery and radiation

By Amit Bhatt, MD

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Cleveland Clinic’s team is among the highest volume centers in the country for the endoscopic treatment of early esophageal and gastric cancer. We have particular expertise in endoscopic submucosal dissection (ESD), a technique that allows us to endoscopically resect early esophageal and gastric cancers despite the size or scarring of a lesion, thereby avoiding a major abdominal or thoracic operation.

Our esophageal and gastric ESD outcomes are exemplary with a > 90 percent curative resection rate, without perforation or recurrence since start of our program.


A 59-year-old female was diagnosed with a large 7 cm esophageal squamous cell cancer (SCC), involving more than two thirds of the circumference of the esophageal lumen during an upper endoscopy for acid reflux.

Due to her chronic obstructive pulmonary disease (COPD), she was told she was high risk for surgical resection, and palliative radiation and chemotherapy was recommended at an outside hospital.

The patient was referred to Cleveland Clinic for a second opinion. Following a multidisciplinary evaluation from our esophageal tumor board, she underwent ESD en-bloc resection of her tumor at our endoscopy suite.

Pathology revealed that despite the large size of the tumor, it was still a superficial T1a cancer, and the endoscopic resection was deemed a curative resection.

The patient recovered well from the procedure, is back to normal preoperative daily activities. She remains cancer-free to date with an excellent quality of life.

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Lesion before treatment.

During ESD.

Immediately after ESD.

6 months after ESD resection of cancer.

The esophageal is well healed.


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