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Gastrointest Endosc. 2008 Dec;68(6):1066-72. doi: 10.1016/j.gie.2008.03.1114. Epub 2008 Jul 11.

Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan.

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1
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka University Graduate School of Medicine, Osaka, Japan.

Abstract

BACKGROUND:

EMR and endoscopic submucosal dissection (ESD) are now being increasingly used for the treatment of esophageal cancers. However, their efficacies in smaller lesions have not been compared.

OBJECTIVE:

For effective use of these methods, we compared the results of ESD and 2 major EMR methods for treating esophageal cancers of <or=20 mm.

DESIGN:

A retrospective study.

SETTING:

A cancer-referral center.

PATIENTS:

A total of 136 patients with 171 lesions <or=20 mm who presented between January 2002 and October 2007 were enrolled.

MAIN OUTCOME MEASUREMENTS:

En bloc and curative resection.

RESULTS:

Of the 171 lesions, 168 were squamous-cell carcinoma and 3 were adenocarcinoma. The en bloc resection rates decreased in the order of ESD (100%), EMR using a transparent cap (EMRC) (87%), and 2-channel EMR (71%). However, the differences showed only marginal significance. The curative resection rate of ESD (97%) was significantly higher than those of the other 2 methods. Furthermore, the curative resection rate of EMRC (71%) was significantly higher than that of 2-channel EMR (46%). In lesions <15 mm, the en bloc and curative resection rates were significantly higher for EMRC (100% and 86%, respectively) than 2-channel EMR (86% and 51%, respectively), whereas no significant differences were found between the en bloc and curative resection rates of EMRC and ESD. There were no differences in the complication rates.

LIMITATIONS:

A single-center, retrospective analysis.

CONCLUSIONS:

ESD was found to be the best endoscopic resection method, even for smaller esophageal cancers. EMRC would be a good alternative to ESD for lesions <15 mm.

PMID:
18620345
DOI:
10.1016/j.gie.2008.03.1114
[Indexed for MEDLINE]

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