Endoscopic submucosal dissection versus endoscopic mucosal resection for type 0-II superficial gastric lesions larger than 20 mm

Abstract

Background:Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are increasingly used for the treatment of superficial gastrointestinal neoplasia. However, the limits and the indications for each technique are still debated. Our retrospective study aimed to compare these techniques in patients with gastric flat lesions larger than 20 mm without the non-lifting sign.Methods:Between January 2013 and July 2016, a total of 36 patients with early gastric flat lesions larger than 20 mm and without the non-lifting sign were resected by ESD and were followed up by endoscopy. As a control group, 40 EMR cases from our database were matched. En bloc and curative resection were compared between the two groups according to histological assessment, tumor size, recurrence, complication rate, and procedure time. A Kaplan-Meier comparison was performed for both groups with a log-rank test to compare the survival curves; the chi-square test was employed for other parameters.Results:En bloc resection rate and curative resection rate were significantly higher in the ESD group than in the EMR group. Procedure time was significantly longer in the ESD group. No significant differences were found in the recurrence and complication rates, although the former were higher in the EMR group and the latter in the ESD group. Survival curves were similar for both groups.Conclusions:Our retrospective analysis seems to confirm a clear advantage for ESD over EMR in removing early superficial gastric neoplasm. Although ESD has expanded the endoscopic resectability of endoscopic gastric lesions, EMR may still be considered one of the therapeutic options for flat gastric lesions without the non-lifting sign.

Comparison of Endoscopic Submucosal Dissection With Endoscopic Mucosal Resection After Circumferential Precutting to Treat Gastric Adenomas ≤15 mm

“…Risk factors that indicate a high risk of high-grade dysplasia or malignancy development are a lesion size of >2 cm and the presence of a depression, a rough or reddish surface, and spontaneous bleeding. Although several previous studies have reported that ESD is more effective than EMR for endoscopic resection of superficial gastric neoplastic lesions, 7,[12][13][14] ESD is associated with a high frequency of complications, such as bleeding and perforation. It requires more time and is costlier than EMR.…”

A 6-year nationwide population-based study on the current status of gastric endoscopic resection in Korea using administrative data

“…Compared to EMR, ESD allows more precise control of the extent and depth of the resection. Since the resection can be done by directly viewing the dissection plane, and fibrotic lesions can be meticulously managed, ESD is considered more appropriate for securing the resection margin 10 , 11 . This is an important issue, especially in the case of gastric cancer, as a negative resection margin is the core factor of curative resection.…”

Complete Closure of Gastric Defect with Improved Purse-String Suture Technique Using Single-Channel Endoscope

“…Standard ESD and EFTR techniques were mentioned previously;[ 1 2 ] endoscopic carbon dioxide insufflation was used during the procedure. The defect was closed immediately with endoloop (LeClamp™ Loop-20 and Loop-30; Leo, Changzhou, China) and metallic clips (Micro-Tech, China) using single-channel endoscope (GIF-Q260J; Olympus, Tokyo, Japan).…”