Modified ESD And Conventional ESD Treatment Comparison Of Surgical Efficiency In Early Esophageal Cancer And Precancerous Lesions

Objective:To compare the efficiency of modified endoscopic submucosal dissection and conventional endoscopic submucosal dissection in the treatment of early esophageal and precancerous lesions,and to provide reference for the treatment of endoscopy.Methods: The clinical data of patients with early esophageal cancer and precancerous lesions treated with ESD from the Second Hospital of Lanzhou University from July 2009 to January 2018 were collected.According to different treatment methods,the patients were divided into the conventional endoscopic submucosal dissection(CESD)group,the tunnel endoscopic submucosal dissection(TESD)group,and the pull-assisted endoscopic submucosal dissection(PESD)group(including in vitro traction and in vivo traction).Retrospective study analysis was performed on the relevant operative time,release time,intraoperative hemostasis time,lesion resection area,exfoliation rate,total resection rate,postoperative discharge time,oncological characteristics,intraoperative and postoperative complications.And so on for comparative analysis.Results: A total of 122 patients were enrolled in this study,with an average age of 60.94 years,100 males,and 22 females.There were 65 patients in the conventional group(CESD),26 in the tunnel group(TESD),31 in the the pull-assisted endoscopic submucosal dissection group(PESD),17 in the in vitro traction ESD group and 14 in the in-vivo traction ESD group.The three groups were gender,age,and tumor.There was no statistical difference in the characteristics of the study.In the three groups of patients,the total resection rate of the lesions was 100%.There was statistically significant difference between the TESD and CESD groups in the overall operative time,lesion dissection time,intraoperative hemostasis time,dissection area,peel rate,longest dissection diameter,postoperative discharge time,and gastrointestinal decompression time(P).<0.05).Even though the TESD group was longer than the CESD group in terms of overall operative time and lesion dissection time,the lesion stripping rate was significantly faster than that of the CESD group,and the TESD group exceeded the CESD group in terms of lesion dissociation area and lesion resection length.In addition,the recovery of TESD was faster than that of CESD,including shorter days of gastrointestinal decompression,average length of stay after surgery,and shorter intraoperative hemostatic time.The overall incidence of postoperative complications was 18.68%,of which CESD group had 3 cases of bleeding,2 cases of perforation,and 3 cases of stenosis;TESD group had 1 case of bleeding,3 cases of perforation,and 5 cases of stenosis.There was statistically significant difference in the overall operation time,lesion removal time,intraoperative hemostasis time,peeling speed,postoperative hospital stay,and gastrointestinal decompression time between PESD group and CESD group(p <0.05);that is,PESD was more than that of CESD.The speed is faster,the overall time of surgery,the time of stripping,the number of hospital days required after surgery,the days of gastrointestinal decompression,and the duration of intraoperative hemostasis are all shorter.There was no significant difference in the area of lesion removal and length of lesion resection between PESD and CESD(p >0.05).The overall incidence of postoperative complications was 12.5%,including 3 cases of bleeding,2 cases of perforation,and 3 cases of stenosis in the CESD group;2 cases of bleeding in the PESD group,0 cases of perforation,and 2 cases of stenosis.Conclusions: TESD,PESD(in vitro traction and in-vivo traction),like CESD,can be used as the first choice for the treatment of early esophageal cancer and precancerous lesions.However,for large area round(more than 1/2 weeks,especially more than 3/4 weeks)EEC and precancerous lesions,TESD stripping speed is faster than CESD,which is more safe and efficient.For patients with small esophageal area(usually no more than 1/2 week),the PESD effect is better than that of CESD.PESD has the advantages of low operative difficulty,short operation time,rapid detachment rate,and less complications.It provides ESD for beginners.A relatively easy way to learn.