Comparison of the Outcome of Endoscopic Submucosal Dissection (ESD) Using Sodium Hyaluronate and Needle-Knife Versus Endoscopic Aspiration Mucosectomy (EAM) for Esophageal Squamous Cell Neoplasm

Abstract

Background and Aims: Endoscopic submucosal dissection (ESD) has been developed for superficial esophageal neoplasm in Japan, because ESD enables large en-bloc resection. En-bloc resection for GI tract lesion is desirable to facilitate accuracy of the histopathological assessment. The aim of this study was to compare the long-term outcomes between ESD and endoscopic aspiration mucosectomy (EAM) for esophageal squamous cell neoplasm. Methods: Between February 2001 and September 2008, a total of 78 patients with esophageal squamous cell neoplasm were treated by ESD or EAM at our institutions. The mean resected size, en-bloc resection rate, histopathological findings, and complications were compared. After initial treatment, all cases were observed (mean period: 32.7 months, range: 2-91 months), and the local recurrence rate and overall survival period of each group were analyzed. Results: Fifty-seven patients were treated by ESD (55 males, median age 67.7, range 38-87) and 21 patients were treated by EAM (19 males, median age 66.0, range 46-83). The mean resected specimen size was 30.8 mm in diameter (range 8-50 mm) for ESD and 21.4 mm in diameter (range 12-40 mm) for EAM (P<0.01). The en-bloc resection rate was 98.2% and 61.9% in the ESD and EAM groups, respectively (P<0.01). Histopathologically, there were 48 cases of squamous cell carcinoma (SCC) and 9 dysplasias with the ESD group, and 14 SCC and 7 dysplasias with the EAM group. The negative horizontal margin rate was 89.4% and 57.1% for the ESD and EAM groups, respectively (p<0.01). The negative vertical margin rate was 91.2% and 80.9% for the ESD and EAM groups, respectively (P=0.24). There were 8 cases of complications in the ESD group (4 cases of stenosis and 4 cases of perforation), and 0 cases in the EAM group. Among the patients with perforation, 1 case was successfully treated by emergency surgery and others were managed conservatively. The local recurrence rate was 1.7% in the ESD group, and 4.7% in the EAM group (P=0.47). One patient died from pancreatic cancer in the ESD group, and 2 patients died from radiative pneumonia and acute myocardial infarction. No patient in either group died from any associated complications or esophageal cancer. Conclusions: On the basis of our results, ESD using sodium hyaluronate and a needle-knife was able to accomplish en-bloc resection and achieved larger resection than EAM. In either group, the local recurrence rate remained very low; thus, there were no patients who died from esophageal cancer. Therefore, ESD is suitable for large superficial esophageal neoplasms.