The Comparative Study Of Endoscopic Submucosal Dissection And Endoscopic Mucosal Resection In The Therapy Of Early Upper Gastrointestinal Cancer And Precancerous Lesions

Objective:To evaluate the outcomes of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) in the management of early upper gastrointestinal cancer and precancerous lesionsMethods:We just chose patients from those who have been diagnosed as early upper gastrointestinal cancer and precancerous lesions by NB1 and chromoendoscopy and biopsy in Shan Dong Provincial Hospital from January 2008 to January 2011.Then we gave endoscopic ultrasound examination to those patients and chose the patients whose lesions limited to mucous layer and submucous layer 1.66 lesions in 59 patients entered our research.40 lesions were treated by endoscopic mucosal resection and 26 lesions were treated by endoscopic submucosal dissection. There were 48 males and 11 females, and the ratio was 4.4:1. The average age was 57.4 years. We compared the tumor size, the operation time, the en bloc resection rate, the complete resection rate, the recurrence rate and the incidence of complications between the two treatments and got the conclusion.Results:12 lesions in 10 patients were diagnosed as cancers and 54 lesions in 49 patients were diagnosed as precancerous lesions by biopsy before the operation.According to the final pathology results,15 lesions in 14 patients have been confirmed as cancers and 51 lesions in 45 patients as precancerous lesions. The diagnostic accuracy was 66.7%. The mean size of the 66 lesions was 14.3 mm (range 5-30 mm) in length and 13.2 mm in EMR treatment group and 16 mm in ESD treatment group (P>0.05). The mean operating time was 39.4 min (range 4-143 min), and 26 min in EMR group,60 min in ESD group (P<0.05).58 of the 66 (87.9%)lesions were resected in one piece. The rate of en bloc resection with ESD (100%;26/26) was significantly higher compared with that for EMR (80%;32/40) Histologically, curative resection was found in 54 (81.8%) lesions.The rate of curative resection with ESD (96.2%;25/26) was significantly higher compared with that for EMR (72.5%;29/40). When the tumor size was smaller than 20 mm, there was no obvious difference between the rate of en bloc resection with ESD (100%) and EMR (90.6%, P>0.05), also as the rate of curative resection with ESD (94.1%) and EMR (81.3%, P>0.05).When the tumor size was larger than 20 mm, the rate of en bloc resection with ESD (100%) was significantly higher compared with that for EMR (37.5%, P<0.05), also as the the rate of curative resection (ESD 100%:EMR 37.5%, P<0.05). There was no obvious difference between the bleeding rate in EMR group (10%)and ESD group (15.4%, P>0.05). Perforation was found in 1 (3.8%,1/26) patient in ESD group. All complications were managed endoscopically.There was no procedure-related mortality. The mean follow-up period was 8.8 months (range 2-38 months). There was no stenosis occurred.The recurrence rate is 1.5%(1/66). Conclusion:Endoscopic submucosal dissection has the advantage of achieving en bloc resection rate and curative resection rate in the therapy of early upper gastrointestinal cancer and precancerous lesions.It has a good prospect. But the operation is more complicated,needs more time and causes more complications, like bleeding and perforation. So EMR is still a better choice for lesions less than 20 mm.