内镜黏膜下剥离术与内镜下黏膜切除术治疗早期食管癌及癌前病变的临床效果及基于病灶大小的亚组分析OA

Objective:To explore the clinical efficacy of endoscopic submucosal dissection(ESD)versus endoscopic mucosal resection(EMR)for early esophageal cancer(EEC)and precancerous lesions,with a subgroup analysis based on lesion size.Methods:We retrospectively reviewed 320 EEC or precancerous lesion patients treated with ESD or EMR in the Endoscopy Room of Nanchong Psychosomatic Hospital Affiliated to North Sichuan Medical College from January 2021 to January 2024.The clinical efficacy and 1-year prognosis were com-pared between the two groups,including:① lesion resection outcomes(en bloc resection rate,complete resection rate,cur-ative resection rate,and residual lesion rate);② perioperative indicators(operation time,intraoperative blood loss,postop-erative pain score,and hospital stay);③ postoperative complications(bleeding,perforation,stenosis,infection,etc.);and ④ one-year local recurrence rate.Furthermore,a subgroup analysis stratified by lesion size was performed to compare the therapeutic outcomes of ESD and EMR.Results:The en bloc resection rate,complete resection rate,and curative resec-tion rate of ESD group patients were higher than those of EMR group,and the residual lesion rate was lower than that of EMR group,with statistical significance(P<0.05).The ESD group had a significantly longer operative time but lower intraoper-ative blood loss and postoperative pain scores than the EMR group(all P<0.05).No statistically significant differences were observed between the two groups in both the overall complication rate and the local recurrence rate(P>0.05).In the small lesion subgroup,patients undergoing ESD demonstrated significantly higher rates of en bloc,complete,and curative re-section,alongside a lower residual lesion rate,compared to those treated with EMR.Operative time was longer but intraoper-ative blood loss was lower in the ESD group,with all these differences being statistically significant(all P<0.05).Howev-er,there were no significant differences in postoperative complications or the 1-year local recurrence rate between the two groups(P>0.05).In the large lesion subgroup,the ESD group demonstrated significantly higher rates of en bloc,com-plete,and curative resection,and a lower residual lesion rate,compared to the EMR group.Moreover,both the operative time and intraoperative blood loss were significantly greater in the ESD group(all P<0.05).Postoperative complication rates did not differ significantly(P>0.05),but the 1-year local recurrence rate was significantly lower in the ESD group(P<0.05).Conclusion:For the small lesion subgroup,both ESD and EMR are safe and effective.While ESD requires a longer operative time,it achieves significantly higher rates of en bloc and curative resection.For large lesions,ESD demon-strates a clear therapeutic advantage by improving en bloc and curative resection rates and reducing the local recurrence rate.However,its application in such cases necessitates careful management of potential complications,notably intraoperative bleeding.