title: Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis.
abstract: OBJECTIVE
  Esophageal endoscopic submucosal dissection (ESD) is technically challenging because of the thinner wall and narrow lumen. The tunnel technique was proposed previously. This current retrospective study aimed to evaluate the efficacy of the tunnel technique in ESD of superficial esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  Patients who underwent ESD for superficial ESCC between October 2013 and September 2015 were included in the study. Propensity score matching was used to compensate for the differences in age, sex, resected specimen size, and pathology. Treatment outcomes were compared with conventional statistic methods between the tunnel ESD group and conventional ESD group after matching. To further explore the potential variables relevant to procedure time, univariate and multivariate logistic regression analyses were applied.
  
  
  RESULTS
  A total of 115 lesions were included in the analysis. Propensity score matching analysis created 38 matched pairs. There was no difference on en bloc resection rate, complete resection rate, and curative rate between the 2 groups. The ESD procedure time was 38.0 (range 29.5-46.0) minutes in the tunnel ESD group and 48.0 (35.4-83.3) minutes in the conventional ESD group (P = .006). There was no difference in adverse events including postprocedural bleeding, perforation, and chest pain, but a lower rate of muscular injury (28.9% vs 52.6%; P = .036) and a less-frequent use of coagulation forceps (36.8% vs 65.8%; P = .012) were shown in the tunnel ESD group. In multivariate regression analysis for procedure time, the tunnel ESD technique (odds ratio [OR] 3.42; 95% confidence interval [CI], 1.32-8.85; P = .011) and specimen size <40 mm (OR 8.74; 95% CI, 1.30-58.5; P = .026) were associated with a shorter procedure time.
  
  
  CONCLUSIONS
  The endoscopic submucosal tunnel dissection improved the efficacy and safety of the ESD procedure by shortening the procedure time and reducing injury to the muscular layer.
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.affiliation: Information Technology Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Cai
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Lu
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Wenhao
authors.initials: W
authors.lastname: Lv
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Kaichun
authors.initials: K
authors.lastname: Wu
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Han
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002637:Chest Pain / Q000453:epidemiology; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden