ESD Versus EMR for Resecting Esophageal Neoplasia
Prateek Sharma, MD, FASGE, reviewing Genere JR, et al. Gastrointest Endosc 2020 Apr.
Endoscopic submucosal dissection (ESD) is an effective method of resecting larger superficial esophageal lesions en bloc; however, it is fraught with advanced training needs, longer procedure times, and a higher risk of complications compared to endoscopic mucosal resection (EMR). A novel articulating knife for ESD (ESD-AR) was approved in 2016, and this retrospective study was designed to evaluate the safety and efficacy of ESD-AR compared to widespread EMR, which is the resection of multiple pieces of tissue using an EMR device.
A total of 115 patients (72 ESD-AR cases and 72 EMR cases) with comparable baseline characteristics except for anticoagulant use (higher in the ESD-AR group) were included in the study. En bloc, radical, and curative resections were noted in 83%, 42%, and 24%, respectively, of the ESD-AR group. Postresection diagnosis was changed in 55% and 39% of the cases after ESD-AR and EMR, respectively, with a greater portion of them being in the ESD-AR group (27.5% vs 12%; P=.05). The ESD-AR group compared to the EMR group had a significant increase in the use of general anesthesia (24% vs 5%; P<.01), and the ESD-AR procedures took twice as long to perform (79.1 mins vs 37.2 mins; P<.01). While no perforations were noted in either group, there were 2 adverse events reported in the ESD-AR group (one transient ischemic attack from holding anticoagulation and one periprocedural post-ESD ulcer bleed).
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Genere JR, Priyan H, Sawes T, et al. Safety and histologic outcomes of endoscopic submucosal dissection with a novel articulating knife for esophageal neoplasia. Gastrointest Endosc 2020;91:797-805. (https://doi.org/10.1016/j.gie.2019.12.016)