Application of single-wide-tunnel endoscopic submucosal dissection with single-clip-line traction for large early esophageal cancer and precancerous lesions

Objective To explore the application value and safety of endoscopic submucosal dissection (ESD) and multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and precancerous lesion. Methods Seventy-two cases of early esophageal cancer and precancerous lesion that underwent endoscopic therapy from January 2010 to April 2016 in the Wuhan Central Hospital were registered for the study. The patients in the ESD group (60 cases) received ESD, while the patients in the EMBM group (12 cases) received EMBM. Retrospective analyses were made on such indicators as surgical time and treatment results, pathological diagnosis, incidence rates of long and short-term complications, and therapeutic efficacy. Results Pathological results indicated that there were 28 cases of low-grade intraepithelial neoplasm (LGIN) precancerous lesion, 16 cases of high-grade intraepithelial neoplasm ( HGIN) precancerous lesion and 16 cases of early esophageal cancer (EEC). The lengths of the foci were 2-6 cm, with an average length of(3.2±0.6)cm and the average surgical time was(82.1±7.5)min. Pathological detection showed that in the EMBM group there were 3 cases of LGIN, 4 cases of HGIN and 5 cases of EEC. The lengths of the foci were 3-10 cm, with an average length of(4.8±0.8)cm and the average surgical time was(35.0±5.1) min. The rate of retrosternal pain after surgery was 41.7% (30/72), the rate of hemorrhage was 1.4%(1/72), and the rates of perforation, esophageal stricture, abdominal pain and fever were respectively 1.4%(1/72), 5.6%(4/72), 11.1%(8/72) and 11.1%(8/72). Pathological detection indicated that in the ESD group complete resection in the cases of LGIN was 96.4%(27/28), complete resection in the cases of HGIN was 93.8%(15/16)and complete resection in the cases of EEC was 100%(16/16). Pathological detection after surgery indicated that the incision edges of the foci were all negative. In the ESD group, there were no cases with lesions penetrating into the muscular layer of mucosa and further into the submucous layer, while there were 2 cases in the EMBM group with lesions penetrating into the submucous layer. Examination by gastroscopy in 62 cases 2 months after surgery revealed that the healing rate of the wound surface was 100% (62 /62), and there was only 1 case that had residual incomplete healing. Fifty-eight cases had gastroscopy 6 months after surgery, and detection results indicated that there was only 1 case that had local recurrence, and 56 cases had gastroscopy 12 months after surgery, and detection results revealed that there was no case of local recurrence. 16.7% of the patients(2/72)that had residual foci or local recurrence were all the patients from the EMBM group. Conclusions ESD and EMBM were safe and effective therapeutic methods for the treatment of early esophageal cancer and precancerous lesion. ESD could completely remove foci with just one incision, with the advantages of easy pathological detection, low rates of recurrence and complication, and low injury, while EMBM on the other hand was a more prompt, safe and effective method for the treatment of lesion with broad foci, however it could not provide complete pathologic data. Key words: Esophageal neoplasm; Precancerous state; Endoscopic submucosal dissection; Endoscopic multi-band mucosectomy

Objective To investigate the clinical effect of endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions. Methods 60 cases of early esophageal cancer and precancerous lesions were removed by ESD at our center from June, 2015 to June, 2017. Results All the 60 had successful dissection, with an average operating time of 65 min. The maximum size of the resection was 32 mm×25 mm, and the minimum 14 mm×11 mm. Eight cases had different degrees of hemorrhage; and the electrocoagulation of the thermal biopsy forceps was successfully stanched; and 2 cases of hemorrhagic mass had successful hemostasis by metal titanium clip. The scope of two cases was more than 75% of the total circumstance of their esophagus, and had difficulty swallowing three months after the operation; the gastroscope indicated the esophageal stenosis, and they were improved after endoscopic expansion. Four cases showed varying degrees of chest pain, and relieved after symptomatic treatment. No one got esophageal perforation, fever, or hematemesis. After the operation, the results showed that 30 cases had early squamous carcinoma and 30 high level intraepithelial neoplasia. They were followed up 3, 6, 12, 24 and 36 months after the operation. The follow-up rate and survival rate both were 100%. No recurrence, lymph node metastasis, and distant metastasis were found. Conclusion ESD in determining the scope of early esophageal cancer and precancerous lesions and infiltration depth on the basis of detachment, is a safe, effective and minimally invasive endoscopic treatment method. It can be used as a new kind of standard treatment for early esophageal cancer and precancerous lesions in clinic. Key words: Endoscopic submucosal dissection; Early esophageal cancer; Precancerous lesions

The objective of this study was to evaluate the clinical value of endoscopic submucosal dissection (ESD) in the treatment of early esophageal cancer and precancerous lesions. We retrospectively analyzed 58 patients who suffered from early esophageal and precancerous lesions and received ESD in the First Affiliated Hospital of Zhengzhou University from February 2012 to January 2016. The clinical efficacy and safety of ESD in treating the early esophageal cancer and precancerous lesions was evaluated by analyzing the operation successful rate, postoperative pathology, complications, and follow-up data of patients who received ESD. For the 58 patients, ESD was successfully completed in 56 cases with a success rate of 96.6%, whereas ESD was unsuccessful in 2 cases. Invasive lesions were observed in the esophageal muscular layer of 1 patient. Consequently, surgery was terminated and this patient was transferred to thoracotomy surgical intervention involving radical resection of esophageal cancer. Esophageal perforation was observed during the annular incision of the esophageal mucosa in another patient with early-stage cancer. This perforation was occluded with an endoscopic titanium clip and surgery was terminated. Intraoperative blood loss in 56 patients was ranged from 10 to 90 mL with an average of 28.3 ± 17.2 mL. The diameter of ESD resection lesion was varied from 2 to 6.0 cm with an average of 3.4 ± 1.1 cm. For the 56 patients, enbloc resection was performed in 50 patients, with an enbloc resection rate of 89.3%. Complete lesion resection was performed in 49 patients, with a complete resection rate of 87.5%. For all patients, 36 manifested with severe atypical hyperplasia confirmed by postoperative pathology, 11 showed moderate atypical hyperplasia, 2 showed carcinoma insitu, and 7 presented with esophageal squamous cell carcinoma. In these 7 patients, 6 patients whose lesions limited to their mucosa were in the early stage of cancer while 1 patient with esophageal cancer involving the incisal edge, and the submucosal layer was subjected to additional surgical treatment. In addition, 1 patient experienced postoperative delayed hemorrhage (1.79%), 6 patients suffered from fever (10.71%), 33 patients reported substernal burning pain (58.93%) that mostly lasted 1-2 days before spontaneous remission, 1 patient was observed intraoperative perforation (1.79%), and 3 patients showed postoperative esophageal stenosis (5.36%), received multiple balloon dilatations, and consumed fluids afterward. Follow-up visits were facilitated for 49 patients for more than 1 year, and their median follow-up time was 36 months. Of these patients, recurrence was observed in 3 patients, with a recurrence rate of 6.1% (3/49). Of these 3 patients, 2 received surgical treatment and 1 underwent another endoscopic lesion resection. No patient died of esophageal cancer during follow-up. ESD was safe and reliable for the treatment of early esophageal cancer and precancerous lesions, and its recurrence and complication rates were low. Complete pathological information could be obtained after operation, which could be applied to assess patients' condition accurately.

Objective To investigate the technical feasibility and oncological safety of EPMR for early esophageal cancer and precancerous lesions. Methods Clinicopathological data, procedure quality and complications of 70 patients with early esophageal cancer or precancerous lesions were retrospectively analysed. The technical safety and feasibility were assessed, and the complications were investigated through postoperative surveillance. The results were compared with published data from two high-quality meta-analysis studies on ESD. Results In a total of 70 patients who underwent EPMR, 35.7%(25/70) were diagnosed as having early esophageal cancer and 64.3%(45/70) atypical hyperplasia. And tumor size greater than 2 cm was 78.6%(55/70). The mean EPMR time was(28.31±9.49) minutes. The R0 resection rate of EPMR was 88.6%(62/70) and no perforation occurred. The bleeding rate was 21.4%(15/70). The esophageal stricture rate was 1.4%(1/70). The recurrence rate was 2.9%(2/70). Compared with published ESD data from the two studies, EPMR showed shorter procedure time, lower curative rate and lower rates of stricture and perforation, but slightly higher rates of bleeding and recurrence. Conclusion Both EPMR and ESD are feasible and effective for early esophageal cancer and precancerous lesions. The curative results of EPMR are similar to ESD, with shorter procedure time, but higher bleeding and recurrence rates. Key words: Early esophageal cancer; Esophageal precancerous lesions; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection

To evaluate the safety and prognosis for patients with early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD). A total of 89 patients were admitted to the Department of internal medicine in the First People's Hospital of Anqing from August 2008 to August 2011. All patients were treated with ESD at the early stage of esophageal cancer and precancerous lesions. The patients' laboratory data and relevant medical history were collected. The postoperative complications and long-term effects of ESD were analyzed. Eighty-nine patients were followed up with 100% response rate. Among 89 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The one-time whole piece resection rate, complete resection rate and curative resection rate was 93.3% (84/89), 92.1% (82/89) and 92.1% (82/89), respectively. Two cases suffered intraoperative perforation with a rate of 2.2% and these 2 patients performed the intraoperative endoscopic repair; one case suffered the postoperative delayed bleeding with a rate of 1.1% and the patient underwent the conservative treatment; three cases suffered the esophageal stenosis with a rate of 3.4%. All patients were followed-up for 10-58 (36.3±21.2) months. In this period, one case recurred after ESD for 3 years with a rate of 1.1%; two cases were dead. The three-year survival rate was 97.8%. The early esophageal cancer and precancerous lesions can be treated with ESD. The method is safe and the prognosis is good.

This study aimed to analyze the risk factors for complications after endoscopic treatment of early esophageal cancer and precancerous lesions and provides evidence for developing preventive measures against these complications. The clinical data of patients with early esophageal cancer and precancerous lesions treated in the Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College from January 2009 to December 2015 were analyzed. The risk factors related to delayed bleeding, perforation, and stenosis were assessed. Of 459 patients, 15 (3.3%) had delayed bleeding, 16 (3.5%) had perforation, and 82 (17.9%) had stenosis. Conservative treatment was performed for patients with bleeding and perforation, and endoscopic dilation was performed to relieve stenosis. The independent risk factors for delayed bleeding were lesion size (OR = 1.51, P = 0.020), circumferential diameter [odds ratio (OR) = 1.24, P = 0.037]. The kind of operation method [endoscopic submucosal dissection (ESD)/cap-based endoscopic resection (EMR-Cap): OR = 15.38, P = 0.013) was the independent risk factor for perforation. The independent predictors of stenosis were circumferential diameter (OR = 1.58, P < 0.001), lesion in the neck (OR = 0.12, P = 0.003), and surgical time (OR = 1.02, P = 0.007). Few complications occur after the endoscopic treatment of early esophageal cancer and precancerous lesions which can be treated by endoscopic and conservative medical therapies. Strict operational training is required for ESD treatment.

Objective To compare the effectiveness and safety of endoscopic submucosal dissection (ESD) with endoscopic piecemeal mucosal resection (EPMR) for early esophageal cancer and precancerous lesions with length more than 5 cm. Methods A retrospective analysis was performed on data of 85 patients diagnosed as early esophageal cancer and precancerous lesions with length more than 5 cm in Fujian Medical Association of Early Esophageal Carcinoma from January 2012 to July 2017. The patients were divided into ESD group (52 cases) and EPMR group (33 cases), and the effectiveness and safety between the two groups were compared. Results There was no significant difference on the complete resection rate between the two groups[86.5% (45/52) VS 87.9% (29/33), P>0.05]. The operative time (58.53±30.50 min VS 32.06±9.12 min), postoperative fasting time (4.18±1.30 d VS 3.67±0.96 d), postoperative hospital-stay time (7.45±2.44 d VS 6.54±1.73 d), and postoperative antibiotics using time (3.48±2.33 d VS 1.96±2.20 d) in ESD group were higher than those in EPMR group (all P 0.05). But the postoperative stricture rate of ESD group was higher than that of EPMR group[23.1% (12/52) VS 6.1% (2/33), P 0.05). Conclusion ESD and EPMR have equivalent efficacy and safety on the treatment of early esophageal cancer and precancerous lesion. EPMR has a shorter operative time, lower rate of post-operative stricture, and is easier to master. Key words: Esophageal neoplasms; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection; Efficiency; Safety

Objective: This study aimed to compare the differences between narrowband imaging (NBI) and Lugo’s iodine staining endoscopy (LCE) for detecting and elucidating the site, clarity, and diagnostic accuracy of early esophageal cancer and precancerous lesions. Methods: We included patients with a high risk of developing esophageal cancer who visited the Zhongjiang County People’s Hospital between October 2020 and October 2022. Endoscopic examination was performed on each study participant. White-light endoscopy was used to observe and locate the diseased mucosa, after which NBI mode and LCE staining were used to observe the boundary between the diseased and normal mucosa. Abnormal lesions were found, and biopsies were performed on the identifiable diseased parts for pathological examination. Inflammation, LGIN, HGIN, and early esophageal cancer were diagnosed, and the differences between them were compared in terms of the two enhanced-image endoscopy techniques. A semantic segmentation model based on deep learning was adopted to assist in the diagnosis of early esophageal cancer and accurately locate cancerous areas. In order to improve its accurate diagnostic rate, we also built a semantic segmentation network model to assist in the computer-aided diagnosis of early esophageal cancer. Results: A total of 69 cases of early esophageal cancer were included in this study. The patients were aged 40–75 years, with an average age of [Formula: see text] years. Most early esophageal cancer lesions were located in the middle of the esophagus in 45/69 (65.2%) cases. LCE obtained higher clarity of lesion boundaries than NBI (59.4% versus 45.0% and 27.7% versus 15.9%, respectively), and the proportion of unclear lesions was lower (8.6% versus 21.7% and 4.3% versus 17.4%, respectively; [Formula: see text]). For early esophageal cancer and precancerous lesions, the missed-diagnosis rate of white-light endoscopy was 20%, that of NBI was 3.15%, and that of LCE was 0%, with statistical significance ([Formula: see text]). The rate of missed diagnosis of LGIN (three cases) by NBI was 3.15%, which was not significantly different from that of LCE ([Formula: see text]). We found that the lesion area could be more accurately determined using deep learning models to segment NBI images. By constructing a deep learning model for the diagnosis and classification of esophageal cancer, its diagnostic rate rose to 99.5%. Conclusion: The age range of patients with early esophageal cancer in Zhongjiang County, Sichuan Province, was 40–75 years, and tumors mostly occurred in the middle of the esophagus. The boundary clarity of early esophageal carcinomas was higher on LCE than that on NBI. The diagnostic accuracies of NBI and LCE are much higher than those of conventional white-light endoscopy. Therefore, both LCE and NBI are helpful for detecting early esophageal cancer and precancerous lesions. Moreover, the diagnostic rate of clinical esophageal cancer can be effectively improved using a dedicated deep learning network model.

Esophageal cancer is a disease with high morbidity and mortality, exploring effective treatment methods is the key to the treatment of this disease. This study aims to compare the clinical efficacy and safety of multi-band mucosectomy (MBM) and endoscopic submucosal dissection (ESD) in the treatment of single early esophageal cancer (EEC) and precancerous lesions, and whether MBM can achieve better clinical effect as an effective treatment method. The clinical data of 70 patients with EEC and precancerous lesions who were treated with MBM and ESD in the Fourth Affiliated Hospital of China Medical University from May 2021 to May 2023 and could be followed up were retrospectively analyzed. They were divided into two groups according to different treatment methods: MBM group (31 cases) and ESD group (39 cases). The general data, perioperative conditions, endoscopic treatment effect and pathological results of the two groups were compared. The duration of endoscopic treatment in MBM group was shorter than that in ESD group [36 (25~39) min vs 46 (41~57) min, p < 0.05], and there was no significant difference in the intraoperative bleeding rate between the two groups (12.90% vs 7.69%, p > 0.05). There was no significant difference in the rate of intraoperative perforation between the two groups (3.23% vs 7.69%, p > 0.05), and the hospitalization time in MBM group was shorter than that in ESD group [5 (4~7) days vs 8 (7~12) days, p < 0.05]. The hospitalization cost was less [2535 (2423~2786) dollars vs 4485 (3858~5794) dollars, p < 0.05]. No postoperative bleeding occurred in both groups. There was no statistically significant difference in postoperative stenosis rate between MBM group and ESD group (3.23% vs 12.82%, p > 0.05), and no statistically significant difference in postoperative local recurrence rate (12.90% vs 5.13%, p > 0.05). There was no significant difference in the rate of additional surgery (9.68% vs 2.56%, p > 0.05). The en bloc resection rate of MBM group was lower than that of ESD group (77.42% vs 97.44%, p < 0.05), but there was no significant difference in the complete resection rate between the two groups (87.10% vs 97.44%, p > 0.05). The postoperative pathological results of MBM group showed 13 cases of low-grade intraepithelial neoplasia (LGIN), 11 cases of high-grade intraepithelial neoplasia (HGIN), and 7 cases of canceration, while the postoperative pathological results of ESD group showed 10 cases of LGIN, 14 cases of HGIN, and 15 cases of canceration, with no statistical significance (p > 0.05). MBM and ESD are effective methods for the treatment of EEC and precancerous lesions. MBM has the advantages of short hospital stay, quick recovery and low cost. However, compared with MBM, ESD can improve the complete resection rate of the lesion, avoid the occurrence of positive incisal margin, and reduce the risk of secondary treatment and additional surgery.

Objective To evaluate the safety and efficacy of multi-band mucosectomy （MBM） for early esophageal cancer and precancerous lesions. Methods Data of 28 patients with early esophageal cancer or precancerous lesions undergoing MBM were reviewed in regarding of procedure complications and follow-up results. Results A total of 32 lesions were resected successfully by MBM in one session, with mean procedure time of 28.3 minutes. The mean diameter of specimens was 12mm. No residual neoplasm was found at the base of any resected specimens. The post-MBM pathological findings consisted of 2 cases of in- tramucosal cancer, 1 case of submucosal cancer, and 25 cases of moderate-severe dysplasia. No perforation, delayed hemorrhage or subcutaneous emphysema occurred. Intraoperative bleeding occurred in 23 cases, including 3 cases of pulsatile bleeding, which were controlled with metal clip, and 20 cases of minor bleeding which were managed with APC or halted automatically at the end of procedure. Chest pain after the procedure occurred in 5 cases and were relieved soon. The patient with submucosal cancer underwent subsequent surgical resection, with no residual cancer in surgical specimen or lymph node metastasis. Twenty seven other cases were followed up endoscopically for 2-12 months. Esophageal stricture occurred in 2 cases, and were successfully relieved by dilatation with stent or bougienage. No recurrent lesion or metastasis were revealed. Conclusion MBM is a relatively safe and effective endoscopic technique for treatment of early esophageal intramucosal cancer and precancerous lesions, but further studies are needed to evaluate the long-term resuits. Key words: Endoscopic surgical procedures; Multi-band mucosectomy; Early esophageal cancer; Precancerous lesion

Esophageal stricture is a common complication after endoscopic submucosal dissection (ESD) for superficial esophageal cancer and precancerous lesions, we intend to investigate the independent risk factors of esophageal stricture after ESD by adding the data of included living habits, established a nomogram model to predict the risk of esophageal stricture, and verified it by external data. The clinical data and living habits of patients with early esophageal cancer and precancerous lesions who underwent ESD in the Affiliated Hospital of North Sichuan Medical College and Langzhong People's Hospital from March 2017 to August 2021 were retrospectively collected. The data collected from the two hospitals were used as the development group (n = 256) and the validation group (n = 105), respectively. Univariate and multivariate logistic regression analyses were used to determine independent risk factors for esophageal stricture after ESD and establish a nomogram model for the development group. The prediction performance of the nomogram model is internally and externally verified by calculating C-Index and plotting the receiver operating characteristic curve (ROC) and calibration curve, respectively. The results showed that Age, drinking water temperature, neutrophil–lymphocyte ratio, the extent of esophageal mucosal defect, longitudinal diameter of resected mucosa, and depth of tissue invasion (P < 0.05) were independent risk factors for esophageal stricture after ESD. The C-Index of the development group and validation group was 0.925 and 0.861, respectively. The ROC curve and area under the curve (AUC) of the two groups suggested that the discrimination and prediction performance of the model were good. The two groups of calibration curves are consistent and almost overlap with the ideal calibration curve, indicating that the predicted results of this model are in good agreement with the actual observed results. In conclusion, this nomogram model has a high accuracy for predicting the risk of esophageal stricture after ESD, providing a theoretical basis for reducing or avoiding esophageal stricture and guiding clinical practice.

Objective:To explore the efficacy and safety of endoscopic submucosal dissection (ESD) in patients with early gastrointestinal (GI) cancer and precancerous lesion.Methods:A total of 132 patients with early GI cancer or precancerous lesion who underwent surgery at Zunhua People’s Hospital between March 2021 and June 2023 were retrospectively analyzed. Among them, 65 patients underwent endoscopic mucosal resection (EMR) (Control group), and 67 underwent ESD (ESD group). Perioperative information, treatment outcomes, stress response indicators, miR-146a and miR-199a levels, and incidence of postoperative complications were compared between the two groups.Results:Surgery duration in the ESD group was significantly longer than that in the Control group. However, the intraoperative blood loss in the ESD group was lower, and the duration of anal ventilation and hospitalization was longer than in the Control group (P<0.05). Total treatment efficacy of the ESD group was significantly higher compared to the Control group (P<0.05). After the surgery, levels of serum cortisol (Cor), norepinephrine (NE), epinephrine (E), and aldosterone (ALD) in both groups significantly increased compared to those before the surgery, and were significantly lower in the ESD group compared to the Control group (P<0.05). After the surgery, expression levels of miR-146a in both groups significantly decreased, while miR-199a levels significantly increased compared to the preoperative levels, and the difference in the ESD group was more significant than in the Control group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05).Conclusions:In patients with early GI cancer or precancerous lesion, ESD can reduce surgical trauma, improve the expression of miR-146a and miR-199a, and alleviate the degree of surgical stress response. ESD is safe and is associated with improved treatment effectiveness and reduce occurrence of complications.

To evaluate the long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions. One-hundred and seventy-one cases with early esophageal cancer (intramucosal carcinoma) and precancerous lesions were treated by APC from 1994 to 2005, and all the cases were followed up. One-hundred and sixty-eight (98.2%) cases were follow-up by endoscopic examination for several times. On average, each patient was endoscopically examined 2.8 times. The follow-up rate was 100%. The precancerous lesion group had 160 patients. They were followed up for 5 years. 11 patients died of causes unrelated to cancer. The lesions developed into esophageal squamous cell carcinoma in five patients ( 2 died and 3 underwent esophagectomy). The remaining 144 cases survived without cancer. In this group, the esophageal cancer incidence rate is only 3.1% (5/160). The early cancer (i.e. intramucosal cancer) group had 11 patients. During the 5-year follow-up period, two patients died of causes unrelated to cancer,six patients had recurrence (4 patients died and 2 patients underwent esophagectomy), and only 3 patients survived without cancer. Therefore, the 5-year survival rate was only 27.3% (3/11). The APC therapy for precancerous lesions of the esophagus is effective and successful. Indications should be carefully considered when treating early esophageal cancer such as intramucosal carcinoma by APC therapy.

The objective of the study was to compare the effects of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early oesophageal cancer. Eighty-six patients with early oesophageal cancer and precancerous lesions admitted to our hospital from November 2021 to December 2023 were randomly divided into a treatment group (ESD: 43 cases) and control group (EMR: 43 cases). The efficacy and safety of the two methods were compared. The operation time of ESD was 117.65 ± 19.98, which was longer than that of EMR group (P < 0.05). The hospitalization time of patients in the ESD group was shorter than that in the EMR group (7.51 ± 1.30 vs. 9.16 ± 2.01 days, P < 0.05). Comparable en bloc resection rate, complete resection rate, and curative resection rate of patients in the ESD group (100.0%, 95.35%, and 93.02%) and EMR group (100.0%, 93.02%, and 90.70%) were observed (P > 0.05). The incidence of postoperative complications in the ESD group was 4.65%, which was lower than 13.95% in the EMR group (P > 0.05). No recurrence or metastasis of the primary lesions occurred in both groups. Both groups were displaying better postoperative life quality comparing to that of pre-operation. The quality of life in the ESD group was significantly better than that of the EMR group (P < 0.05). Compared with EMR, ESD showed better clinical effects, fewer postoperative complications and higher safety in treating early oesophageal cancer and precancerous lesions. However, the diameter of the lesion should be considered for an optimal surgical plan.

Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection(ESD) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD.The pathological features of all resection margins in the specimen and the follow-up outcome of the patients with positive resection margin were evaluated. Univariate and multivariate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions, there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion(submucosal layer invasion, P=0.048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension(≥3/4, P=0.014) and the depth of invasion(exceeding muscularis mucosa, P=0.007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD. Key words: Endoscopic submucosal dissection; Early esophageal carcinoma; Precancerous lesion; Positive resection margin