Comparative Study Of Endoscopic Mucosal Resection And Endoscopic Submucosal Dissection In The Treatment Of Gastrointestinal Lesions

Objective: To compare and analyze the curative effect,operation technique and complications of the two kinds of minimally invasive endoscopic techniques EMR and ESD in the treatment of gastrointestinal lesions,and compare their respective advantages.Methods: A retrospective analysis in January 2014 to 2015 August in our hospital endoscopy center of endoscopic minimally invasive technique for the treatment of gastrointestinal lesions in patients with clinical data.The endoscopic mucosal resection surgery in the treatment of 42 cases(EMR)group,the endoscopic submucosal dissection for a total of 40 cases(ESD)group,comparative analysis the two groups of patients with surgical time-consuming,en bloc resection rate,the rate of complete resection,the time and the cost of hospitalization,complications,postoperative residual rate and recurrence rate.Results: 1.The distribution of lesions: EMR group distribution of the 7patients with esophageal and distribution in the stomach,duodenum(n = 20)and distribution in 15 cases of colorectal cancer.The ESD group distribution in 8 cases of esophageal and distribution in the stomach and duodenum(n =23),distribution in 9 cases of colorectal cancer and the lesion distribution had no significant difference(P > 0.05).2.operation completion time: EMR group operation completion time15-54 min,median time 26.5min,ESD group operation time 32-165 min,median time 40.5min,has the remarkable difference(P<0.05).3.Enbloc resection rate and the rate of complete resection,EMR group en bloc resection rate,complete resection rate were 61.90%(26 / 42),57.14%(24 / 42),and ESD group en bloc resection rate,complete resection rate was95.0%(38 / 40),87.5%(35 / 40),the differences were significantly(P <0.05).4.Surgical resection or peeling lesion size: EMR group resection of the lesion size 0.7-3.2cm,the average size of 1.22 + 0.86cm;ESD group size of the lesion 1.2-5.6cm and average size of 2.14 + 1.53 cm,ESD and EMR group,the difference is statistically significant(P < 0.05).5.The pathological results: surgical resection histopathology of 82 lesions showed that which leiomyoma 21(25.6%)cases,tubular adenoma 13(15.9%)cases,atypical hyperplasia in 10 cases(12.2%),inflammatory polypoid hyperplasia 13(15.9%)cases,gastrointestinal stromal tumor(accounted for6.1%)cases,ectopic pancreatic tissue 5(6.1%)cases,lipoma was found in 5(6.1%)cases,mucosa in severe inflammation in 5(6.1%)cases,inflammatory myofibroblastic tumor 1 case(1.2%),4(4.9%)cases of malignant tumor.6.Complications: groups of EMR or ESD in bleeding rate was 7.1%(3 / 42),10%(4 / 40),delayed bleeding rates are 1(2.4%),2(5%),are controlled bleeding,the difference was not statistically significant(the perforation rate was 0(0 / 42)in P > 0.05).EMR group and the ESD group,12.5%(5 / 40);subcutaneous emphysema or pneumoperitoneum respectively 2.4%(1 / 42),15%(6 / 40),the differences were statistically significant(P < 0.05).7 hospitalization time and operation cost: EMR group and ESD group length of stay were(4.55 + 0.97d),(5.53 + 1.04d),the operation cost was(2909.62 +486.35 yuan),(3970.60 + 429.95 yuan),the difference was statistically significant(P<0.05).8.Residual rate and recurrence rate: EMR group residual rate was 7.14%(3 /42),postoperative pathological 2 cases were tubular adenoma,1 cases for moderate atypical hyperplasia.ESD group residual rate was 2.5%(1 / 40),postoperative pathology showed moderate atypical hyperplasia,residual rate had no significant difference.During follow-up no recurrence.Conclusion(s): 1.Compared with EMR,ESD operation time is long,the length of hospital stay,operation cost is high.2 Compared to the treatment effect,ESD not only the whole resection rate,the total resection rate is higher than EMR,but also more than EMR can be removed to remove larger lesions.3.ESD surgery in the treatment of gastrointestinal lesions occurred perforation and subcutaneous emphysema or pneumoperitoneum with EMR high,but residual disease rate is low.Research shows that,compared with surgery,EMR and ESD in the treatment of gastrointestinal lesions is safe,effective,economical,reliable,specific,or to according to the patients with lesions circumstances choose EMR or ESD.Two kinds of endoscopic technique can be widely promoted in the primary hospital and serve more patients.