Comparison Between Different Methods Of Endoscopic Mucosal Dissection In Treatment Of Superficial Esophageal Cancer And Precancerous Lesions

Objective:To compare the effectiveness,efficacy and safety of endoscopic submucosal dissection(ESD),endoscopic submucosal tunnel dissection(T-ESD)and endoscopic submucosal dissection with C-shaped incision(C-ESD)for treatment of esophageal superficial neoplasms and precancerous lesions.Methods:A retrospective study was performed on clinical data of patients with esophageal superficial neoplasms and precancerous lesions who were treated by conventional ESD,T-ESD or C-ESD in our hospital between 2017 and 2021.The characteristics of neoplasms,the procedure time,the dissection area,the dissection speed,the rate of en bloc resection,curative resection and adverse events were compared among the three groups.Results:A total of 297 patients were collected in the study,with an average age of(63.26±7.36)years,including 182 males and 115 females,including 96 undergoing ESD,103 undergoing T-ESD and 98 undergoing C-ESD.There were no statistically significant differences in characteristics of tumor,age and gender among the three groups.C-ESD had a shorter procedure time than other two methods and the dissection speed of C-ESD was faster than other two methods;C-ESD and T-ESD had a larger dissection area than ESD.The en bloc resection rate of three groups were 100%,the rate of curative resection of C-ESD,T-ESD and ESD were 87.76%,90.29%and 86.46%respectively.There were no statistical differences on adverse event rates including intra-procedure bleeding,muscular injury,perforation,delayed bleeding and postoperative adverse symptoms.T-ESD group and C-ESD group showed higher rate of post-procedure esophageal stenosis than ESD group.A multivariate regression analysis for stenosis showed that dissection area,circumferential range and muscular injury were associated with post-procedure esophageal stenosis.Conclusion:C-ESD,T-ESD and ESD are safe and effective for treatment of esophageal superficial neoplasms and precancerous lesions.C-ESD can shorten operative time,improve dissection speed.