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


METHODS
A retrospective study.


METHODS
A cancer-referral center.


METHODS
A total of 136 patients with 171 lesions <or=20 mm who presented between January 2002 and October 2007 were enrolled.


METHODS
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.


CONCLUSIONS
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.
Ishihara
Ryu
R
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka University Graduate School of Medicine, Osaka, Japan.
Iishi
Hiroyasu
H
Uedo
Noriya
N
Takeuchi
Yoji
Y
Yamamoto
Sachiko
S
Yamada
Takuya
T
Masuda
Eriko
E
Higashino
Koji
K
Kato
Motohiko
M
Narahara
Hiroyuki
H
Tatsuta
Masaharu
M
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies