Outcomes of Endoscopic Submucosal Dissection Versus Endoscopic Mucosal Resection in Management of Superficial Squamous Esophageal Neoplasms Outside Japan

Abstract

This study aims to evaluate the outcomes of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) in management of superficial squamous esophageal neoplasms. Endoscopic resection is a potential alternative in treatment of superficial squamous esophageal neoplasms. However, there have been limited reports comparing the outcomes of ESD versus EMR in the treatment of these lesions outside Japan. A retrospective analysis of all patients with high-grade superficial neoplasms (moderate to severe dysplasia and noninvasive carcinoma) or intramucosal carcinoma resected endoscopically between January 2002 and December 2007 was carried out. Clinical and pathologic outcomes were compared. ESD was done in 22 lesions (18 patients) and cap-EMR in 13 lesions (10 patients). ESD allowed resection of larger lesions indicated by a significantly longer endoscopic length (P=0.015), larger specimen size (P<0.001), and more lesions extending for more than half the circumference of the esophagus (P=0.005) when compared with cap-EMR. ESD also achieved with a higher en bloc resection rate (P=0.052) and lower piecemeal resection rate (P=0.015). Procedure-related morbidities were not significantly different (P=1.0). There was no procedure-related mortality in the entire series. ESD allows en bloc resection of larger mucosal lesions of the esophagus, earlier not possible by cap-EMR. This is achievable without significantly increasing the risks to the patient even in low-volume centers outside Japan. Whether ESD decreases the local recurrence and improves survival when compared with cap-EMR will require further long-term follow-up studies.