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

  • Wang, Jing ;
  • Ge, Jian ;
  • Zhang, Xiao-Hua ;
  • Liu, Ji-Yong ;
  • Yang, Chong-Mei ;
  • Zhao, Shu-Lei
  • Published : 2014.02.28


Endoscopic submucosal dissection (ESD) was originally developed for en bloc resection of large, flat gastrointestinal lesions. Compared with endoscopic mucosal resection (EMR), ESD is considered to be more time 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 EMR for such lesions. We searched databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 for related trials. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histologically resection rate and the local recurrence rate. We also compared the operation time and the incidences of procedure-related complications. Five trials were identified, and a total of 710 patients and 795 lesions were included. The en bloc and histologically complete resection rates were higher in the ESD group compared 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 local recurrence rate was lower in the ESD group (OR 0.13, 95 % CI 0.04-0.43). The meta-analysis also showed ESD was more time consuming, but did not increase the complication rate (P=0.76). The results implied that compared with EMR, ESD showed better en bloc and histologically resection rates, and lower local recurrence, without increasing the incidence of procedure-related complications in the treatment of early esophageal carcinoma.


Endoscopic submucosal dissection;endoscopic mucosal resection;early esophageal carcinoma


  1. Yamashita T, Zeniya A, Ishii H, Tsuji T, et al (2011). Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma. Surg Endosc, 25, 2541-6.
  2. Teoh AY, Chiu PW, Yu Ngo DK, et al (2010). Outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection in management of superficial squamous esophageal neoplasms outside Japan. J Clin Gastroenterol, 44, e190-4.
  3. Urabe Y, Hiyama T, Tanaka S, et al (2011). Advantages of endoscopic submucosal dissection versus endoscopic oblique aspiration mucosectomy for superficial esophageal tumors. J Gastroenterol Hepatol, 26, 275-80.
  4. Yamamoto H, Koiwai H, Yube T, et al (1999). A successful single-step endoscopic resection of a 40 millimeter flatelevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc, 50, 701-4.
  5. Inoue H, Minami H, Kaga M, Sato Y, Kudo SE (2010). Endoscopic mucosal resection and endoscopic submucosal dissection for esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am, 20, 25-34.
  6. Chen SB, Weng HR, Wang G, et al (2013). Surgical treatment for early esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 14, 3825-30.
  7. Hirao M, Masuda K, Asanuma T, et al (1988). Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc, 34, 264-9.
  8. Iishi H, Uedo N, Takeuchi Y, et al (2008). Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc, 68, 1066-72.
  9. Kato M (2005). Endoscopic submucosal dissection (ESD) is being accepted as a new procedure of endoscopic treatment of early gastric cancer. Intern Med, 44, 85-86.
  10. Lian J, Chen S, Zhang Y, Qiu F (2012). A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc, 76, 763-70.
  11. Ohkuwa M, Hosokawa K, Boku N, et al (2001). New endoscopic treatment for intramucosal gastric tumors using an insulatedtip diathermic knife. Endoscopy, 33, 221-6.
  12. Ono H, Kondo H, Gotoda T, et al (2001). Endoscopic mucosal resection for treatment of early gastric cancer. Gut, 48, 225-9.
  13. Tada M, Murakami A, Karita M, Yanai H, Okita K (1993). Endoscopic resection of early gastric cancer. Endoscopy, 25, 445-50.
  14. Takahashi H, Arimura Y, Masao H, et al (2010). Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc, 72, 255-64.
  15. ASGE TECHNOLOGY COMMITTEE, Kantsevoy SV, Adler DG, Conway JD, et al (2008). Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc, 68, 11-8.
  16. Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J, et al (2013). Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract. World J Gastroenterol, 19, 1953-61.
  17. Cao Y, Liao C, Tan A, et al (2009). Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy, 41, 751-7.

Cited by

  1. Prognostic Significance of Beta-Catenin Expression in Patients with Esophageal Carcinoma: a Meta-analysis vol.15, pp.15, 2014,
  2. Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries vol.21, pp.26, 2015,
  3. Endoscopic Management of Benign Esophageal Ruptures and Leaks vol.15, pp.2, 2017,
  4. Current Status and Future Prospects for Esophageal Cancer Treatment vol.23, pp.1, 2017,