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

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


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.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery*
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery*
  • Esophagoscopy*
  • Female
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Mucous Membrane / surgery
  • Neoplasm Staging
  • Retrospective Studies