A pilot study comparing specimen quality of ESR and EMR

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Surgical Pathology

Background:

• Endoscopic submucosal resection (ESR) is an advanced technique for resecting gastrointestinal lesions.
• ESR utilizes a specialized snare for deep submucosal dissection, potentially offering advantages over endoscopic mucosal resection (EMR).
• This study focuses on comparing specimen quality between ESR and EMR, specifically regarding submucosal tissue preservation.

Purpose of the Study:

• To compare the quality of specimens obtained via ESR versus EMR in rectal neoplasms.
• To evaluate the impact of resection technique on histopathological assessment.
• To assess en bloc resection rates, complications, and recurrence rates associated with both techniques.

Main Methods:

• A retrospective single-center study analyzing specimens from large flat or sessile rectal neoplasms.
• Comparison of specimen quality using a validated semiquantitative histopathology score (0-5 points).
• Evaluation of secondary outcomes including en bloc and R0 resection rates, complications, and recurrence rates.

Main Results:

• Optimal histopathology scores were achieved in 66.6% of ESR specimens versus 7.1% of EMR specimens (p=0.005).
• ESR demonstrated significantly higher en bloc resection rates (67% vs. 28%, p<0.001).
• No significant differences were observed in R0 resection, complication, or recurrence rates between the two methods.

Conclusions:

• Endoscopic submucosal resection (ESR) yields superior specimen quality compared to endoscopic mucosal resection (EMR).
• The enhanced specimen integrity from ESR facilitates more accurate histopathological evaluation.
• ESR is particularly beneficial for neoplastic lesions where submucosal invasion is suspected.