Endoscopic dissection of early pharyngeal tumors can not only reduce various sequelae that traditional surgical procedures may cause, but also effectively shorten the postoperative recovery period.Recently,the Department of Gastroenterology at the First People’s Hospital of Zhenjiang City innovatively performed endoscopic submucosal dissection (ESD)for the first time, treating a 70 years old Mr.Zhou (pseudonym) with a tumor in the lower pharynx. The successful implementation of this surgery has further expanded the scope of ESD treatment.
In early March this year,Mr.Zhou discovered high-grade intraepithelial neoplasia of the pharynx during a gastroscopy review at the First Hospital of the city,which is a disease belonging to precancerous lesions.When Mr.Zhou saw this diagnosis ,he had mixed feelings because it was the second time in nearly two years that he had discovered a cancer-related disease through gastroscopy.In 2022,at the same hospital in the city,Yao Jun,the director of the Department of Gastroenterology,discovered sigmoid colon cancer,gastric mucosal lesions,and atypical hyperplasia of the esophageal mucosa.Due to timely ESD treatment,the further deterioration of the lesions was delayed.
The incidence rate of hypopharyngeal problems found in this reexamination is not high clinically.According to the traditional treatment method,surgery is the main method,but this operation method has a great impact on the swallowing,voice production and taste function of patients.Considering that the elderly meet ESD indications such as mucosal tumor and no lymph node metastasis,from the patient’s perspective,Yao Jun thought about whether minimally invasive ESD treatment of the mucosa can be used.
What is ESD？
ESD is a tumor resection surgery performed through gastroscopy or colonoscopy with special surgical instruments.Previously,it was mainly used to remove tumors in the mucosal layer and submucosal layer of the stomach,intestines,esophagus,and other areas,as well as larger flat polyps in these areas.Due to the fact that surgical instruments enter the natural lumen of the human body for surgical operations,patients generally recover quickly after surgery.
ESD surgical steps：
However, the operating space for pharyngeal surgery is relatively small, with a wide upper part and a narrow lower part, resembling a funnel shape. There are also important tissues such as cricoid cartilage around it.Once the operations is performed to the nearest millimeter, it will cause various serious complications such as laryngeal edema.Moreover,there is not much literature on lower pharyngeal ESD both domestically and internationally, which means that the successful surgical experience available for Yao Jun’s reference is also quite limited.However,in recent years, the gastroenterology department of the first hospital in the city has accumulated a considerable amount of surgical experience with an annual ESD surgery volume of 700-800 cases, which has enabled Yao Jun to accumulate considerable surgical experience. After consulting with multiple disciplines such as otolaryngology, head and neck surgery, and general surgery, he became even more confident in the application of ESD in new fields. One day after surgery,Mr.Zhou was able to eat without any complications such as hoarseness. He has now recovered and been discharged from the hospital.
(China Jiangsu Net reporter Yang Ling, Tang Yuezhi, Zhu Yan)
Post time: May-08-2024