This study aimed to assess both short-term safety and long-term outcomes of whole circumferential endoscopic submucosal dissection (WC-ESD) for esophageal squamous cell carcinoma (ESCC) with tumor length > 50 mm, and to evaluate effectiveness of aggressive prophylactic dilation combined with steroid therapy in preventing esophageal stricture.

A retrospective review was conducted on 67 patients who underwent WC-ESD for superficial ESCC between 2009 and 2019 at a single Japanese center. Patients were categorized into > 50-mm and ≤ 50-mm groups. The primary endpoint was incidence of post-ESD stricture in the main analysis excluding surgery/chemoradiotherapy cases within 90 days; sensitivity analysis included all patients. Secondary endpoints were number of dilations, steroid use, and long-term survival outcomes (overall survival [OS], disease-specific survival [DSS], relapse-free survival [RFS]).

Stricture incidence was not significantly different (> 50 mm vs. ≤ 50 mm: 13% vs. 18%, P = 0.708; sensitivity: 21% vs. 15%, P = 0.538). Although dilations were more frequent in the > 50-mm group (96% vs. 83%), median sessions were similar (8 vs. 7.5). Prophylactic dilation plus steroids reduced refractory strictures (25%→7%, P = 0.03). For pT1a-EP/LPM cases, 5-year OS, DSS, and RFS were 100% in both groups. In pT1a-MM/pT1b cases, survival was comparable, although OS tended to be lower with > 50-mm lesions (68.9% vs. 100%, P = 0.07).

WC-ESD for superficial ESCC with a tumor length > 50 mm did not increase adverse events and provided comparable long-term survival. These findings support feasibility beyond guideline limits and emphasize further refinement of stricture prevention.

Received: 16 February 2025

Accepted after revision: 21 October 2025

Accepted Manuscript online:
01 December 2025

Article published online:
19 December 2025

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Takakazu Miyake, Hiroaki Takahashi, Satoshi Okahara, Ayumu Takizawa, Takashi Yokoyama, Junichi Kodaira, Keisuke Ishigami, Shinji Yoshii, Hiroshi Nakase. Clinical outcomes of circumferential endoscopic submucosal dissection in esophageal squamous cell carcinoma > 50 mm: Retrospective cohort study. Endosc Int Open 2025; 13: a27606112.
DOI: 10.1055/a-2760-6112