ESD versus EMR for precancerous lesions and early cancer at gastroesophageal junction

Abstract

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for precancerous lesions and early cancer at gastroesophageal junction （GEJ） by comparing endoscopic mucosal resection （EMR） with ESD. Methods Data of patients with GEJ precancerous lesions or early cancer, who received EMR （n = 51 ） or ESD （n = 28 ） were reviewed to compared the en bloc resection rate, R0 resection rate, operation time, complication and recurrence rate between 2 methods, Results En bloc resection and R0 resection rates of ESD group （92. 9%, 78. 6% respectively） were significantly higher than those of EMR group （45. 1%, 43. 1% respectively）. Local recurrence rate in ESD group （3.6% , 1/28） was significantly lower than that of EMR group （19. 6% ）. Complications including perforation, delayed hemorrhage, stricture were not significantly different between EMR and ESD groups. Mean operation time of ESD group （64. 3 ±27. 1 min） was significantly longer than that of EMR group （27.6± 14. 1 min） （P 〈 0. 05 ）. Conclusion ESD, with a higher cure rate and en bloc rate and a lower local recurrence rate, is superior to EMR for precancerous lesions and early cancer at GEJ. Key words: Gastroesophageal junction; Neoplasms ; Endoscopic mucosal resection; Endo- scopic submucosal dissection