The Superiority of Endoscopic Submucosal Dissection to Endoscopic Mucosal Resection for Achieving Negative Margins in Adenocarcinomas of the Gastroesophageal Junction: A Histopathological Evaluation

Abstract

Background: Due to the significant morbidity associated with esophagectomy, advanced endoscopic therapies have been developed for diagnosis and resection of gastroesophageal junctional (GEJ) adenocarcinomas. Aim: To compare two commonly employed techniques, namely endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for efficacy in removing GEJ adenocarcinomas. Methods: A retrospective review of all adenocarcinomas at the GEJ removed via EMR or ESD over a ten-year period with coexisting BE (2004-2014) was performed. Thirty-one cases met the study inclusion criteria. All cases were re-reviewed by a gastrointestinal pathologist, and a chi-square analysis of all variables including tumor stage, degree of differentiation, depth of invasion, presence of lymphovascular invasion, and margin status was performed to evaluate for statistically significant differences between EMR and ESD. Results: ESDs were significantly more likely than EMRs to yield negative margins (64.3% vs. 35.7%; pvalue= 0.026). ESDs also produced fewer positive deep margins than EMRs; however, when the deep margin was analyzed independently, this number did not quite reach statistical significance (30.8% vs. 69.2%; p-value=0.057) Conclusion: This study demonstrates that ESD is superior to EMR for achieving negative margins in endoscopically resected adenocarcinomas at the GEJ. ESD also allows for better margin assessment histologically by the pathologist. Further, we believe that as the number of ESDs performed increases, we will also see that ESD will be more likely to provide both deep and lateral margin negativity.