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 ≤20 mm. Design: A retrospective study. Setting: A cancer-referral center. Patients: A total of 136 patients with 171 lesions ≤20 mm who presented between January 2002 and October 2007 were enrolled. Main Outcome Measurements: 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. Limitations: 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.