{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:22:03Z","timestamp":1782886923862,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective study enrolled 101 patients with early CRC or precursor lesions. EMR (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f53) or ESD (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f48) 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\u202fmonths assessed recurrence at the resection site at the 12-month follow-up. Subgroup analyses included lesion diameter, location, pathology, and EMR resection type.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For lesions \u226520\u202fmm, ESD achieved higher en bloc (91.2% vs. 71.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.036), complete (85.3% vs. 62.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.034), and curative (82.4% vs. 60.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041) resection rates than EMR. Outcomes were similar for lesions &amp;lt;20\u202fmm. Subgroup analysis showed a greater ESD benefit for lesions \u226530\u202fmm. Right-colon ESD had a significantly higher complication rate than EMR (40.0% vs. 6.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.046). For high-grade dysplasia\/cancer, en bloc resection was numerically higher with ESD (93.8% vs. 70.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.076). 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\u201310.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.008). At 12-month surveillance colonoscopy (median follow-up, 12.0\u202fmonths), recurrence was 2.1% (1\/48) for ESD and 11.3% (6\/53) for EMR (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.072).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For lesions \u226520\u202fmm, ESD provides superior resection outcomes, particularly for lesions \u226530\u202fmm, but with higher complication rates, especially in the right colon. For lesions &amp;lt;20\u202fmm, EMR is preferred. When en bloc EMR is not feasible, ESD should be prioritized over piecemeal EMR, particularly for lesions \u226530\u202fmm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1849920","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:00:40Z","timestamp":1782882040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic mucosal resection versus endoscopic submucosal dissection for early colorectal cancer and precursor lesions: a retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Mengyuan","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Civil Aviation General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanjuan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Civil Aviation General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Civil Aviation General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangqin","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Civil Aviation General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Civil Aviation General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.suc.2023.11.009","article-title":"Screening for colorectal cancer","volume":"104","author":"Jacobsson","year":"2024","journal-title":"Surg Clin North Am"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.tips.2023.01.003","article-title":"Metastatic colorectal cancer: mechanisms and emerging therapeutics","volume":"44","author":"Shin","year":"2023","journal-title":"Trends Pharmacol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.gtc.2024.08.018","article-title":"Advances in endoscopic resection","volume":"53","author":"Esaki","year":"2024","journal-title":"Gastroenterol Clin N Am"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/den.13545","article-title":"Japan gastroenterological endoscopy society guidelines for colorectal endoscopic submucosal dissection\/endoscopic mucosal resection","volume":"32","author":"Tanaka","year":"2020","journal-title":"Dig Endosc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3748\/wjg.v25.i3.300","article-title":"Endoscopic resection techniques for colorectal neoplasia: current developments","volume":"25","author":"Dumoulin","year":"2019","journal-title":"World J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"941","DOI":"10.17235\/reed.2020.6681\/2019","article-title":"Endoscopic mucosal resection versus endoscopic submucosal dissection for colorectal laterally spreading Tumors: a Meta-analysis","volume":"112","author":"Zhao","year":"2020","journal-title":"Rev Esp Enferm Dig"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.21037\/tcr-21-2074","article-title":"Endoscopic resection for colorectal laterally spreading Tumors in east Asian countries: a systematic review","volume":"11","author":"Liu","year":"2022","journal-title":"Transl Cancer Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.lers.2025.09.004","article-title":"Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal neoplasia: a systematic review and meta-analysis","volume":"8","author":"Abbas","year":"2025","journal-title":"Laparosc Endosc Robot Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (Strobe) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1097\/cm9.0000000000003253","article-title":"Chinese National Clinical Practice Guidelines on prevention, diagnosis and treatment of early colorectal Cancer","volume":"137","author":"Li","year":"2024","journal-title":"Chin Med J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/s0016-5107(03)02159-x","article-title":"The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002","volume":"58","year":"2003","journal-title":"Gastrointest Endosc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1007\/s002680010154","article-title":"Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer","volume":"24","author":"Kudo","year":"2000","journal-title":"World J Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1111\/den.12644","article-title":"Narrow-band imaging (Nbi) magnifying endoscopic classification of colorectal Tumors proposed by the Japan Nbi expert team","volume":"28","author":"Sano","year":"2016","journal-title":"Dig Endosc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1055\/s-0043-102569","article-title":"Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline","volume":"49","author":"Ferlitsch","year":"2017","journal-title":"Endoscopy"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s00384-025-05069-4","article-title":"Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of rectal Tumors extending to the dentate line: a systematic review and Meta-analysis","volume":"41","author":"Ding","year":"2026","journal-title":"Int J Color Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3390\/gastroent17010018","article-title":"Risk factors of adverse outcomes for colorectal Esd after generalization of the technique\u2014a multi-Centre retrospective study in Hong Kong","volume":"17","author":"Hon","year":"2026","journal-title":"Gastroenterol Insights"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3262","DOI":"10.1007\/s00464-013-2903-x","article-title":"Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan","volume":"27","author":"Nakajima","year":"2013","journal-title":"Surg Endosc"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1007\/s00464-015-4392-6","article-title":"Clinical outcomes of endoscopic submucosal dissection for large colorectal neoplasms: a comparison of protruding and laterally spreading Tumors","volume":"30","author":"Bae","year":"2016","journal-title":"Surg Endosc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1016\/j.cgh.2025.02.021","article-title":"Endoscopic submucosal dissection for previously attempted colorectal lesions: an international multicenter experience","volume":"23","author":"Arayakarnkul","year":"2025","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1097\/mog.0000000000001140","article-title":"Endoscopic mucosal resection or endoscopic submucosal dissection: choosing the right tool to a polyp-free Colon","volume":"42","author":"Wahba","year":"2026","journal-title":"Curr Opin Gastroenterol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1055\/s-0034-1364970","article-title":"Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and Meta-analysis","volume":"46","author":"Belderbos","year":"2014","journal-title":"Endoscopy"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1016\/j.gie.2011.12.022","article-title":"\"underwater\" Emr without submucosal injection for large sessile colorectal polyps (with video)","volume":"75","author":"Binmoeller","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1016\/j.gie.2018.10.023","article-title":"Underwater Emr for colorectal lesions: a systematic review with meta-analysis (with video)","volume":"89","author":"Spadaccini","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"6125","DOI":"10.3390\/jcm14176125","article-title":"Safety and efficacy of simplified Emr versus Esd for rectal neuroendocrine Tumors \u2264 10 mm: a retrospective cohort study","volume":"14","author":"Zou","year":"2025","journal-title":"J Clin Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12893-024-02325-2","article-title":"Cold Emr vs. hot Emr for the removal of sessile serrated polyps larger than 10 mm: a systematic review and Meta-analysis","volume":"24","author":"Ding","year":"2024","journal-title":"BMC Surg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1111\/jgh.15744","article-title":"Comparison of Precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20-30 mm) flat colorectal lesions","volume":"37","author":"Oh","year":"2022","journal-title":"J Gastroenterol Hepatol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1080\/13645706.2026.2642667","article-title":"Endoscopic intermuscular dissection and endoscopic submucosal dissection for treatment of rectal neuroendocrine Tumors: a retrospective cohort study","volume":"35","author":"Han","year":"2026","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1111\/den.14058","article-title":"Cost-effectiveness analysis of endoscopic resection for colorectal laterally spreading Tumors: endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection","volume":"34","author":"Sekiguchi","year":"2022","journal-title":"Dig Endosc"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.cgh.2015.08.037","article-title":"Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions","volume":"14","author":"Jayanna","year":"2016","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849920\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:00:40Z","timestamp":1782882040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849920\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1849920"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1849920","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1849920"}}