Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma

Background Endoscopic mucosal resection using a cap-fitted panendoscope (EMRC) and an endoscopic submucosal dissection (ESD) are increasingly performed to treat superficial esophageal carcinoma (SEC). As an endoscopic procedure appropriate for en bloc complete resection, ESD requires a much higher level of skill and experience than EMRC. Methods This retrospective study reviewed 127 SECs in 112 patients treated by EMRC or ESD from January 1997 to September 2009. Results For lesions 10 mm in diameter or smaller, EMRC and ESD had equivalent en bloc resection rates with tumor-free margins (en bloc + R0 resection rates). For lesions 11 mm in diameter or larger, however, the rate was significantly higher in the ESD group than in the EMRC group (p < 0.01). The mean procedure time was significantly longer in the ESD group than in the EMRC group (p < 0.01) regardless of lesion size. No significant difference was found in esophageal perforation rate between the EMRC and ESD groups. Severe esophageal stricture developed after EMRC of eight lesions (14.3%) and after ESD of six lesions (8.5%). For patients with a mucosal defect involving more than three-fourths of the esophageal circumference, the incidence of severe esophageal stricture after procedure was significantly higher in the EMRC group than in the ESD group (p < 0.05). The overall local recurrence rate was 3.1% (4/127) during an average follow-up period of 39 months (range, 8-123 months). All local recurrences were detected as superficial cancers after EMRC and then treated endoscopically. Conclusions For lesions 10 mm in diameter or smaller, EMRC was found to be optimal. For lesions 11 mm in diameter or larger, however, ESD was superior to EMRC in efficacy as assessed by the en bloc + R0 resection rate. Furthermore, ESD was advantageous in preventing stricture formation. The operating endoscopist should carefully select EMRC or ESD according to lesion size.