Endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for large superficial esophageal squamous cell neoplasm: efficacy and safety study to guide future practice

Wengang Zhang, Yaqi Zhai, Ningli Chai, Enqiang Linghu, Zhongsheng Lu, Huikai Li, Xiuxue Feng

ESTD and ESD are currently the two primary treatment options for superficial esophageal squamous cell neoplasm (SESCN) in China. However, in larger cases, ESD proves to be technically challenging and time saving, whereas ESTD exhibits promising efficacy. This study aims to evaluate the efficacy and safety of these two techniques for large SESCN. A total of 150 patients with solitary large SESCN that underwent either ESTD (n = 52) or ESD (n = 98) between August 2011 and June 2016 were included in this study. Both efficacy and safety clinical data were collected and analyzed. All of the 150 patients were found to successfully undergo ESTD or ESD with 92.68 ± 67.96 (mean ± SD) min. The specimen area was measured to be 13.79 ± 7.44 (mean ± SD) cm2 and the dissection speed was 17.99 ± 10.40 (mean ± SD) mm2/min. En bloc resection and R0 resection were achieved in 91.33% (137/150) and 86.00% (129/150) of the cases, respectively. A total of 8.67% (13/150) were found to have intra-operative adverse events. Based on statistical analysis, ESTD was found to have a higher dissection speed and a similar adverse event rate compared with ESD. Moreover, a long operation time was found to be an independent risk factor for intra-operative adverse events. ESTD and ESD both were found to be effective and safe treatment options for the treatment of large SESCN. ESTD appeared to improve operation efficacy, which was reflected in a higher dissection speed compared with ESD. We also demonstrate that long operation times should be avoided as much as possible in order to reduce intra-operative adverse events.