How I Do It: ESD Versus EMR for EAC

Endoscopic resection has been proven to be safe and effective for staging and treatment of early esophageal cancer. There are 2 main modalities of endoscopic resection: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR entails snare excision of abnormal mucosa and is the most widely used method for resection of visible lesions in the Barrett’s neoplasia. ESD involves dissection in the submucosal plane using electrosurgical knives enabling enbloc removal of lesion irrespective of the size and therefore useful in management of T1a lesions more than 15 mm in size and in cases where EMR is not technically feasible or inadequate. The various steps in performing these 2 techniques are discussed here.