Zhang D, Hao XX, Zhang C, Liang Y. Efficacy and adverse reactions of endoscopic submucosal dissection and endoscopic submucosal tunnel dissection in early esophageal cancer patients. World J Gastrointest Surg 2026; 18(7): 120740 [DOI: 10.4240/wjgs.v18.i7.120740]
Corresponding Author of This Article
Yan Liang, Research Fellow, Department of Quality Control, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, No. 127 South Siliu Road, Qingdao 266042, Shandong Province, China. nayliang@163.com
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Gastroenterology & Hepatology
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Zhang D, Hao XX, Zhang C, Liang Y. Efficacy and adverse reactions of endoscopic submucosal dissection and endoscopic submucosal tunnel dissection in early esophageal cancer patients. World J Gastrointest Surg 2026; 18(7): 120740 [DOI: 10.4240/wjgs.v18.i7.120740]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 120740 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.120740
Efficacy and adverse reactions of endoscopic submucosal dissection and endoscopic submucosal tunnel dissection in early esophageal cancer patients
Dong Zhang, Xiu-Xian Hao, Chao Zhang, Yan Liang
Dong Zhang, Department of Gastroenterology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266042, Shandong Province, China
Xiu-Xian Hao, Office of the Health Insurance, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266042, Shandong Province, China
Chao Zhang, Department of Health Education, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266042, Shandong Province, China
Yan Liang, Department of Quality Control, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266042, Shandong Province, China
Author contributions: Zhang D and Hao XX contributed to the conceptualization; Hao XX, Zhang C, and Liang Y contributed to methodology; Hao XX performed the investigation; Zhang D and Zhang C conducted the formal analysis; Zhang C and Liang Y conducted the data curation; Zhang D wrote the review; Liang Y wrote the original draft.
AI contribution statement: None of these or any other AI tools were used. The main text of the manuscript was written by the authors without AI-generated. No AI tool used for language polishing, translation, data analysis, or writing assistance of the manuscript. The study design and interpretation of results were carried out by the authors. The authors created all the images without AI tools.
Institutional review board statement: This study strictly adhered to the Declaration of Helsinki and related ethical guidelines for medical research. It received formal approval from the Medical Ethics Committee of the Qingdao Central Hospital.
Informed consent statement: According to the “Ethical Review Measures for Biomedical Research Involving Human Subjects” regarding the ethical requirements for retrospective studies, and considering the characteristics of this study involving no direct intervention, low risk, and adequate protection of subject privacy, the Medical Ethics Committee unanimously agreed to waive the informed consent procedure after review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Yan Liang, Research Fellow, Department of Quality Control, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, No. 127 South Siliu Road, Qingdao 266042, Shandong Province, China. nayliang@163.com
Received: March 10, 2026 Revised: April 15, 2026 Accepted: May 26, 2026 Published online: July 27, 2026 Processing time: 140 Days and 7 Hours
Abstract
BACKGROUND
Esophageal cancer remains a notable global health burden. Endoscopic submucosal dissection (ESD) is a standard treatment for early esophageal cancer, but it has limitations, including risk of incomplete resection and adverse events. Endoscopic submucosal tunnel dissection (ESTD) is a new technique that may offer advantages.
AIM
To compare the efficacy and safety of ESD and ESTD in patients with early esophageal cancer.
METHODS
In this retrospective study, 257 patients were divided into ESD (n = 156) and ESTD (n = 101) groups. The primary endpoints were efficacy (en bloc resection, R0 resection, and recurrence rates) and adverse reactions. The secondary endpoints included operative indicators, inflammatory markers (interleukin-8, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein) measured preoperatively and on postoperative days (3 and 7), and quality of life (General Quality of Life Inventory-74 assessed preoperatively and at 6 months). Multivariate logistic and linear regression models were used to adjust for potential confounders, including demographics and tumor characteristics.
RESULTS
The R0 resection rate in the ESTD group (96.04%) was substantially higher than that in the ESD group (89.10%). The three-year recurrence rate was lower in the ESTD group (4.95%) compared with that in the ESD group (12.82%). The overall incidence of adverse reactions in the ESTD group was lower than that in the ESD group (7.92% vs 17.31%). Compared with ESD, ESTD was associated with a larger dissection area (1548.29 vs 1395.76), higher dissection speed (18.85 vs 16.34), and less intraoperative bleeding (19.42 vs 26.83). The postoperative levels of interleukin-8, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein were consistently low in the ESTD group. At six months, the patients with ESTD exhibited much higher scores across all quality of life domains (all P < 0.05) compared with those in the ESD group. Multivariate analysis confirmed that ESTD independently improved R0 resection [adjusted odds ratios (aOR) = 3.21], reduced three-year recurrence (aOR = 0.31), lowered adverse events (aOR = 0.40), improved the operative indicators, lowered inflammation, and increased the patients’ quality of life (all P < 0.05).
CONCLUSION
ESTD is superior to ESD in treating early esophageal cancer, and it has higher rates of curative resection and lower long-term recurrence and adverse events. It improves operative efficiency, attenuates postoperative inflammation, and enhances quality of life.
Core Tip: This retrospective study provides comparative evidence on the use of endoscopic submucosal tunnel dissection (ESTD) vs conventional endoscopic submucosal dissection in treating early esophageal cancer. We found that ESTD is associated with a high R0 resection rate, low recurrence, and few adverse reactions. Moreover, ESTD demonstrates superior surgical efficiency (short procedure time and reduced bleeding) and attenuates postoperative inflammatory responses, which correlate with improved long-term quality of life. These results position ESTD as a potentially more effective and less traumatic minimally invasive option compared with other approaches, warranting further prospective validation.
