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The following is a summary of “Comparative study on different endoscopic submucosal dissection techniques for the treatment of superficial esophageal cancer and precancerous lesions,” published in the February 2025 issue of BMC Gastroenterology by Jiang et al.

This study aims to systematically compare the effectiveness and safety of three endoscopic techniques—traditional endoscopic submucosal dissection (ESD), endoscopic submucosal tunneling dissection (ESTD), and endoscopic submucosal dissection with a C-shaped incision (ESD-C)—in the treatment of superficial esophageal cancer and precancerous lesions. By analyzing key surgical outcomes, procedural efficiency, and postoperative complications, this study provides clinical insights and guidance for optimizing the management of esophageal cancer.

A retrospective analysis was conducted on the medical records of patients who underwent ESD (n = 96), ESTD (n = 103), and ESD-C (n = 98) for superficial esophageal cancer or precancerous lesions between January 2017 and December 2022. The three techniques were compared in terms of operative time, dissection speed, en bloc resection rates, complete resection rates, and postoperative complications, particularly esophageal stricture. Additionally, risk factors contributing to postoperative esophageal stricture were identified and analyzed.

The findings indicated notable differences among the three techniques. In terms of total operative time and dissection time, the ESD group had the longest duration, followed by the ESTD group, while the ESD-C group demonstrated the shortest duration, reflecting superior procedural efficiency. Dissection speed followed a similar trend, with ESD-C achieving the highest speed, followed by ESTD and ESD. Regarding the dissection area, both the ESTD and ESD-C groups achieved significantly larger resection areas compared to the traditional ESD group. Wound treatment time was also shorter in both the ESTD and ESD-C groups than in the ESD group, further supporting the efficiency of the modified techniques.

All three groups achieved a 100% en-bloc resection rate, demonstrating the efficacy of each technique in lesion removal. The complete resection rates were 86.84%, 90.79%, and 88.16% for the ESD, ESTD, and ESD-C groups, respectively, with no statistically significant differences among them. However, a key concern following these procedures is the development of postoperative esophageal stricture, which was found to be significantly influenced by several factors, including the extent of the dissection area, the circumferential involvement of the lesion, and the degree of muscularis propria injury. Patients with larger resections, greater circumferential involvement, or deeper injury to the esophageal wall were at higher risk for developing strictures, highlighting the need for careful patient selection and postoperative management strategies.

In conclusion, ESD-C emerged as the most efficient technique in terms of operative time, resection speed, and procedural performance, while maintaining comparable effectiveness to ESD and ESTD in achieving complete lesion removal. The study also underscores the importance of recognizing and mitigating risk factors for postoperative esophageal stricture, particularly in patients with extensive resections or deep esophageal wall injury. These findings contribute to a more refined understanding of the comparative advantages of each endoscopic approach, aiding clinicians in selecting the most appropriate treatment strategy for patients with superficial esophageal cancer and precancerous lesions.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03657-w