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Abstract：
Background and Objectives: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both well-established and effective treatments for dysplasia and early cancer in Barrett\'s esophagus (BE). This study aims to compare the short- and long-term outcomes associated with these procedures in treating Barrett\'s neoplasia. Materials and Methods: This single-center retrospective cohort study included 95 patients, either EMR (n = 67) or ESD (n = 28), treated for Barrett\'s neoplasia at Sahlgrenska University Hospital between 2004 and 2019. The primary outcome was the complete (en-bloc) R0 resection rate. Secondary outcomes included the curative resection rate, additional endoscopic resections, adverse events, and overall survival. Results: The complete R0 resection rate was 62.5% for ESD compared to 16% for EMR (p < 0.001). The curative resection rate for ESD was 54% versus 16% for EMR (p < 0.001). During the follow-up, 22 out of 50 patients in the EMR group required additional endoscopic resections (AERs) compared to 3 out of 21 patients in the ESD group (p = 0.028). There were few adverse events associated with both EMR and ESD. In both the stratified Kaplan-Meier survival analysis (Log-rank test, Chi-square = 2.190, df = 1, p = 0.139) and the multivariate Cox proportional hazards model (hazard ratio of 0.988; 95% CI: 0.459 to 2.127; p = 0.975), the treatment group (EMR vs. ESD) did not significantly impact the survival outcomes. Conclusions: Both EMR and ESD are effective and safe treatments for BE neoplasia with few adverse events. ESD resulted in higher curative resection rates with fewer AERs, indicating its potential as a primary treatment modality. However, the survival analysis showed no difference between the methods, highlighting their comparable long-term outcomes.
摘要：
背景和目的：内镜下黏膜切除术（EMR）和内镜下黏膜剥离术（ESD）都是巴雷特食管（BE）不典型增生和早期癌症的有效治疗方法。本研究旨在比较与这些手术治疗Barrett瘤形成相关的短期和长期结果。材料和方法：这项单中心回顾性队列研究包括95例患者，EMR(n=67)或ESD(n=28)，2004年至2019年在Sahlgrenska大学医院接受巴雷特肿瘤治疗。主要结果是完全（整体）R0切除率。次要结果包括治愈性切除率，额外的内窥镜切除，不良事件,和总体生存率。结果：ESD的完全R0切除率为62.5%，而EMR为16%（p<0.001）。ESD的治愈性切除率为54％，而EMR为16％（p<0.001）。在后续行动中,EMR组50例患者中有22例需要额外的内镜切除（AERs），而ESD组21例患者中有3例（p=0.028）。很少有与EMR和ESD相关的不良事件。在分层的Kaplan-Meier生存分析中(Log-rank检验，卡方=2.190，df=1，p=0.139）和多变量Cox比例风险模型（风险比为0.988；95％CI：0.459至2.127；p=0.975），治疗组(EMRvs.ESD)对生存结果没有显著影响。结论：EMR和ESD均是治疗BE瘤形成的有效且安全的治疗方法，不良反应少。ESD导致更高的治愈性切除率和更少的AERs，表明其作为主要治疗方式的潜力。然而,生存分析显示两种方法之间没有差异，强调他们可比的长期结果。
