Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors influencing operative time

Objective To evaluate the efficacy of endoscopic submucosal tunnel dissection (ESTD) in the treatment of esophageal intramucosal and submucosal cancer and explore the factors influencing operation time. Methods A total of 133 patients with esophageal intramucosal and submucosal carcinomas treated at our hospital from November 2015 to December 2018 were retrospectively analyzed. Among them, 80 patients were treated by endoscopic submucosal dissection (ESD; group A) and 53 patients were treated by ESTD (group B). Logistic regression analysis was used to identify the factors influencing operation time. Results There was no significant difference between the two groups in the rates of total excision and radical excision (P>0.05); the total operation time and the time of submucosal dissection in group B were significantly less than those of group A (P 0.05). The rates of muscle layer injury and bleeding during operation in group B were significantly lower than those of group A (P<0.05). Logistic regression analysis showed that ESTD application and lesion area<9 cm2 were independent influencing factors of operation time (P<0.05). Conclusion ESTD for esophageal intramucosal and submucosal carcinomas can effectively shorten total operation time and submucosal dissection time, improve the speed of mucosal dissection, and reduce the incidence of intraoperative myometrial injury and intraoperative bleeding, with a similar overall resection effect to ESD. Operation time is closely related to the type of endoscopy and the area of lesion. Key words: Endoscopic submucosal tunnel dissection; Esophageal neoplasms; Intramucosal cancer; Submucosal cancer; Operation time