Outcomes of endoscopic submucosal dissection for esophageal cancer with segmental absence of intestinal musculature

Perforation during esophageal endoscopic submucosal dissection (ESD) typically results from electrical damage. However, there are cases in which perforation occurs due to segmental absence of intestinal musculature (SAIM) without iatrogenic muscular injury. We investigated the occurrence rate and clinical course of SAIM during esophageal ESD.We conducted a retrospective review of esophageal ESDs performed between 2013 and 2019 in 10 centers in Japan.Five of 1708 patients (0.29%) received ESD for esophageal cancer and had SAIM. The median muscular defect size was 20 mm. All lesions were resected without discontinuation. After resection, three patients were closed with Endoloop. Four patients had mediastinal emphysema. All patients were managed conservatively.SAIM is a very rare condition, which is usually only diagnosed during ESD. Physicians performing esophageal ESD should be aware about SAIM. When SAIM is detected, the ESD technique should be modified to prevent full-thickness perforation.