Abstract: Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic
submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients
undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center
were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large
esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18
received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min,
P<0.05). Despite a similar en bloc rate between the two groups (100%［11/11］vs 88.9%［16/18］, P>0.05), the radical curative rate
of ESTD was significantly greater than that of ESD (81.8%［9/11］vs 66.7%［12/18］, P<0.05). No serious bleeding or perforation
occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps.
Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length
(P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened
operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative
esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or
exceeding 50 mm.