ESD Versus EMR for Resecting Esophageal Neoplasia

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).