The occurrence of esophageal stenosis becomes unavoidable with endoscopic submucosal dissection (ESD) conducted on large superficial esophageal squamous cell neoplasia (SESC). The aim of this study was to assess the impact of neo-adjuvant radiotherapy administered prior to ESD for SESC.

This was a retrospective cohort study in a single tertiary referral center. Medical records were reviewed from January 2017 to November 2023. Inclusion criteria comprised; 1) identification of SESC through endoscopic and pathologic examinations; 2) radiotherapy prior to ESD; 3) no further treatment immediately after ESD. Exclusion criteria encompassed; 1) advanced esophageal carcinoma; 2) esophageal adenocarcinoma; 3) radiotherapy administered after ESD.

In this study, a total of 15 lesions from 14 patients were included. The male-to-female ratio was 11:3, with an average age of 67.4 ± 7.8 years. The mean follow-up period was 29.7 ± 12.3 months. The initial lesion width before radiation therapy averaged 26.7 cm² and averaged 13.0 cm² after ESD. The curative en bloc resection rate was 93.3%, and no submucosal invasion was observed pathologically. Throughout the follow-up period, peri-gastric lymph node metastasis was detected in one patient. Importantly, none of the patients experienced esophageal stricture or disruption in the passage of food materials.

The application of neo-adjuvant radiotherapy before ESD may help prevent post-ESD stricture.