Comparative Analysis Of The Efficacy Of Endoscopic Submucosal Tunnel Dissection And Traditional Submucosal Dissection For Early Esophageal Cancer And Precancerous Lesions

Objective:Through the retrospective analysis of Endoscopic Submucosal Tunnel Dissection(ESTD)and conventional Submucosal Dissection(ESD)related indicators,to evaluate the efficacy and safety of ESTD and ESD in the treatment of early esophageal cancer and precancerous lesions.Methods:A total of 58 patients undergoing endoscopic resection for esophageal neoplasms between September 2017 and December 2019 in the Department of Gastroenterology of the First Hospital of Shanxi Medical University were collected.According to the inclusion and exclusion criteria,36 patients undergoing ESTD or ESD for early esophageal cancer and precancerous lesions were enrolled for data analysis.According to the"endoscopic treatment method",they were divided into the ESTD group or the ESD group.The operation time,dissection area,dissection speed,hospitalization time,en bloc resection rate,complete resection rate,complication rate and postoperative recurrence which reflect the safety and efficiency of the operation were compared and analyzed between the two groups.Results:A total of 36 patients were enrolled in this study,including 16 patients undergoing ESTD and 20 patients undergoing ESD,their age range from 37 to 85 years,and including 21 males and 15 females in this study.Compared with the two surgical methods,the ESTD group has larger dissection area(15.56±5.30cm~2 VS8.85±2.89cm~2,P=0.001),shorter operation time(67.25±20.94min VS 86.00±22.15min,P=0.01),faster dissection speed(21.54±4.09mm~2/min VS 11.23±1.51mm~2/min,P=0.001),and higher complete resection rate(100%VS 70%,P=0.02),the difference between the two groups was statistically significant(P<0.05).However,there was no statistically significant difference between the two groups(P>0.05)in complete resection rate(100%VS 90%,P=0.49)and hospitalization time(11.90±3.35d VS 10.23±2.68d,P=0.23).The incidence of complications was 12.5%(2/16)in the ESTD group,the incidence of complications was 30%(6/20)in the ESD group,it is lower in the ESTD group,but there was no statistically significant difference between the two groups(P>0.05).During postoperative follow-up,none of recurrence was found in the ESTD group,two cases of recurrence were found in the ESD group,there was no statistically significant difference between the two groups(P>0.05).Conclusion:The results of this study confirmed that ESTD is effective and safe in the treatment of early esophageal cancer and precancerous lesions.Compared with ESD,ESTD has the advantages of short operation time,fast stripping speed and high complete resection rate,and is more suitable for stripping large areas of esophageal lesions,which is worthy of clinical promotion and application.In addition,large-scale prospective randomized controlled studies are still needed to confirm the superiority of ESTD technology.