Endoscopic Submucosal Dissection Versus Endoscopic Mucosal Resection for the Treatment of Early Esophageal Carcinoma: a Meta-analysis

Endoscopic submucosal dissection (ESD) was originally developed for en bloc resection of large, flatgastrointestinal lesions. Compared with endoscopic mucosal resection (EMR), ESD is considered to be moretime consuming and have more complications for treatment of early esophageal carcinoma, such as bleeding,stenosis and perforation. The objective of this study was to compare the efficacy and safety of ESD and EMRfor such lesions. We searched databases, such as PubMed, EMBASE, Cochrane Library and Science CitationIndex updated to 2013 for related trials. In the meta-analysis, the main outcome measurements were the en blocresection rate, the histologically resection rate and the local recurrence rate. We also compared the operation timeand the incidences of procedure-related complications. Five trials were identified, and a total of 710 patients and795 lesions were included. The en bloc and histologically complete resection rates were higher in the ESD groupcompared with the EMR group (odds ratio (OR) 27.3; 95% CI, 11.5-64.8; OR 18.4; 95% CI, 8.82-38.59). The localrecurrence rate was lower in the ESD group (OR 0.13, 95 % CI 0.04-0.43). The meta-analysis also showed ESDwas more time consuming, but did not increase the complication rate (P=0.76). The results implied that comparedwith EMR, ESD showed better en bloc and histologically resection rates, and lower local recurrence, withoutincreasing the incidence of procedure-related complications in the treatment of early esophageal carcinoma.