Comparison between tunneling and standard endoscopic submucosal dissection for treatment of large esophageal superficial neoplasm

Background and study aims : Endoscopic submucosal dissection (ESD) has been established as a standard endoscopic method for treating esophageal superficial neoplasms, and it can be performed using a conventional or a tunneling method. The aim of the present study was to compare the safety and efficacy of tunneling ESD (t-ESD) and standard ESD (s-ESD) for treating large esophageal superficial neoplasms and to explore the risk factors for postoperative strictures. Patients and methods : Fifty-five consecutive patients with large esophageal superficial neoplasms were treated by t-ESD or s-ESD. Den u graphics, lesion characteristics, procedure-related parameters, and follow-up results were retrospectively collected to compare the efficacy and safety of these procedures. Multivariate analyses were conducted to deters ' the potential risk factors for postoperative strictures. Results: Of the 55 patients, 13 underwent t-ESD and 42 underwent s-ESD. The dissection speed of t-ESD was significantly faster than that of s-ESD (7.42 +/- 1.99 min/cm' vs. 9.01 +/- 2.11 minkm% P <0.05). En bloc resection was achieved in 98.2% (54/55) of the cases, while RO resection was achieved in 92.7% (51/55). Curative resection was achieved in 78.2% (43/55) of the cases. Fourteen patients (25.5%) had postoperative strictures, which resolved with endoscopic dilation and/or start insertion. Circumferential involvement of >3/4 and lesion length of >3 cm were independent risk factors for strictures. Conclusions : T-ESD is a safe and effective method for treating large esophageal superficial neoplasms with a faster dissection speed than s-ESD, but postoperative strictures may be encountered for lesions invoking more than three-fourths of the circumference or longer than 3 cm.