Endoscopic mucosal resection versus endoscopic submucosal dissection for early colorectal cancer and precursor lesions: a retrospective study.

Authors

Mengyuan Yang, Chanjuan Fan, Zhen Li, Liangqin Pan, Jianping Cheng

Published in

Frontiers in medicine. Volume 13. Pages 1849920. Epub Jul 01, 2026.

Abstract

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.
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.
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).
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.

PMID:
42460082
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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