Safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer

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Objective To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer. Methods A total of 68 patients with large early esophageal cancer accepted endoscopic submucosal dissection (ESD) or endoscopic submucosal tunnel dissection (ESTD) in our center from Jan. 2018 to Aug. 2019. Based on the operation strategy, 45 patients underwent ESD and 23 patients underwent ESTD treatment. Hemorrhage, perforation, dissection speed, curative resection rate and relative clinical date of ESD and ESTD group were collected and analyzed. Results Delayed bleeding occurred in 1 patient (2.2%) of ESD group. There was no significant difference compared with 2 patients (8.7%) of ESTD group (P=0.545). Hemostatic forceps were used to manage bleeding successfully. No perforation was observed in ESD group and intraoperative perforation occurred in 1 patient of ESTD group. No significant difference was observed between two groups (P=0.730). The perforation was treated with fibrin sealant and tissue forceps. 40 patients (88.9%) achieved curative resection and there was no significant difference compared with 21 patients(91.3%) of ESTD group (P=1.000). The dissection speed of ESTD was significantly quicker than that of ESD group(41.8±17.3)mm2/min vs (33.2±13.4)mm2/min(P=0.027). Conclusions ESTD appeared to be comparable with ESD in terms of safety and effficacy for large esophageal cancer. Besides, ESTD could provide a quicker dissection speed. Key words: Early esophageal cancer; Endoscopic submucosal dissection; Endoscopic submucosal tunnel dissection; Safety; Efficacy