Related Experiment Video
Updated: Jul 17, 2026
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Endoscopic mucosal resection versus endoscopic submucosal dissection for early colorectal cancer and precursor
Mengyuan Yang1, Chanjuan Fan1, Zhen Li1
1Department of Gastroenterology, Civil Aviation General Hospital, Beijing, China.
Objective:
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both used for early colorectal cancer (CRC) and precursor lesions, but optimal size thresholds and subgroup-specific outcomes remain unclear. This study aimed to investigate the efficacy and safety of EMR versus ESD for early CRC and precursor lesions.
Patients And Methods:
This single-center retrospective study enrolled 101 patients with early CRC or precursor lesions. EMR (n = 53) or ESD (n = 48) was selected based on lesion size, morphology, and suspected invasion depth. Pre-procedural evaluation included white-light endoscopy, chromoendoscopy, and endoscopic ultrasound/computed tomography for suspected deep invasion. Outcomes were operative time, en bloc, complete, and curative resection, and complications. Surveillance colonoscopy at 3, 6, and 12 months assessed recurrence at the resection site at the 12-month follow-up. Subgroup analyses included lesion diameter, location, pathology, and EMR resection type.
Results:
For lesions ≥20 mm, ESD achieved higher en bloc (91.2% vs. 71.4%, p = 0.036), complete (85.3% vs. 62.9%, p = 0.034), and curative (82.4% vs. 60.0%, p = 0.041) resection rates than EMR. Outcomes were similar for lesions <20 mm. Subgroup analysis showed a greater ESD benefit for lesions ≥30 mm. Right-colon ESD had a significantly higher complication rate than EMR (40.0% vs. 6.3%, p = 0.046). For high-grade dysplasia/cancer, en bloc resection was numerically higher with ESD (93.8% vs. 70.0%, p = 0.076). Complete resection was 40.0% with piecemeal EMR and 93.0% with en bloc EMR. Multivariable analysis identified ESD as an independent predictor of en bloc resection (OR 3.85, 95% CI 1.42-10.43, p = 0.008). At 12-month surveillance colonoscopy (median follow-up, 12.0 months), recurrence was 2.1% (1/48) for ESD and 11.3% (6/53) for EMR (p = 0.072).
Conclusion:
For lesions ≥20 mm, ESD provides superior resection outcomes, particularly for lesions ≥30 mm, but with higher complication rates, especially in the right colon. For lesions <20 mm, EMR is preferred. When en bloc EMR is not feasible, ESD should be prioritized over piecemeal EMR, particularly for lesions ≥30 mm.
