Observation On Therapeutic Effects Of EMR And ESD For Early Gastroesophageal Cancer And Precancerous Lesions

Background China is a country of high incidence of gastrointestinal cancer, but it's often too late when people come to see a doctor on account of the lack of typical symptoms and signs of early gastrointestinal cancer to receive timely treatment. As the development of endoscopic technology, it has made a great progress in the diagnosis of early upper gastrointestinal cancer and precancerous lesions. Therapy of early upper gastrointestinal cancer and precancerous lesions mainly relied on surgery before, but as the development of endoscopic technology, more and more early upper gastrointestinal carcinoma patients chose endoscopic therapy because of its advantages of less invasion lower-cost and higher quality of life after operation. Endoscopic resection of lesions including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), and the yield results that are comparable to surgery. There has been many reports about comparing these two methods with each other in many foreign countries, but less in China.Objective The purpose of this study is to observe the therapeutic effects of EMR and ESD for early gastroesophageal cancer and precancerous lesions.Method We collected and analysised all the 55 patients of early gastroesophageal cancer and precancerous lesions who were diagnosed by normal endoscopy combined with pathology, chromoendoscopy, NBI endoscopy, confocal endoscopy and endoscopic ultrasonography (EUS)and then managed by EMR or ESD in our hospital from March 2007 to March 2011. According to the different treatment, we divided the patients into two treatment groups—EMR group and ESD group, and there are 35 patients in group EMR and 20 patients in group ESD. We compared the size of the lesions, rates of en bloc resection, bleeding, perforation and local recurrence to observe the therapeutic effects of EMR and ESD for early gastroesophageal cancer and precancerous lesions.Results The diameter of lesions in EMR group is from 0.3mm to 2.5cm with an average of 1.25cm and the diameter of lesions in ESD group is between 0.8cm and 4.0cm with an average of 1.83cm and it is significantly different (p=0.0284, p<0.05);The en bloc rates of EMR group is 85.37%(35/41) and in ESD group is 95%(19/20), and there is no significant difference between the two groups(p=0.2678, p> 0.05); Bleeding rate in EMR group is 12.20%(5/41) and in ESD group is 35%(7/20) and it is significantly different (p=0.0354, p<0.05); Perforation rate in EMR group is 0 (0/41) and in ESD group is 10% (2/20) and it is significantly different(p=0.0395, p<0.05); the local recurrence rate of EMR group is 17.07%(5/41) and in ESD group is 0 (0/21) and it is significantly different (p=0.0495, p<0.05).Conclusion ESD showed better local recurrence compared with EMR, but had higher rates of bleeding complications although most of the bleeding are in control, and the perforation rate is higher.