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Background <p>The management of positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) to treat early gastric cancer (EGC) remains controversial. We implemented a sequential therapeutic protocol for post-ESD pLM management; this protocol involved progressing from argon plasma coagulation (APC) and hot biopsy forceps-mediated avulsion to the hybrid endoscopic mucosal resection-hot avulsion (EMR-HA) technique.</p> <p>This study compared the outcomes of EMR-HA with those of thermal ablation (hot avulsion/APC) in the management of residual tumors measuring ≤ 1&#xa0;cm with pLMs after gastric ESD, and both recurrence prevention and therapeutic efficacy were assessed.</p> Methods <p>In a retrospective cohort study (2015–2023) of 1,601 ESD procedures, 92 cases of pLMs with residual tumors that had maximum diameters ≤ 1&#xa0;cm were analyzed. The therapeutic modalities were stratified as follows: hot avulsion (<i>n</i> = 25), APC (<i>n</i> = 41), and EMR-HA (<i>n</i> = 26). Statistical analyses were performed with one-way ANOVA, chi-square tests or Fisher’s exact tests, as well as Kaplan‒Meier analysis.</p> Results <p>EMR-HA resulted in a lower recurrence rate of 11.5% (3/26; median follow-up of 63 months, IQR 41–66), showing superior efficacy to both hot avulsion (44% recurrence, 11/25; <i>P</i> = 0.013) and APC (36.6% recurrence, 15/41; <i>P</i> = 0.046). The thermal ablation cohort exhibited significantly shorter median recurrence intervals (hot avulsion: 20 months; APC: 18 months) than the negative lateral margin cohort (32 months; <i>P</i> &lt; 0.05). Among the 42 patients who experienced recurrence, complete resection was achieved via re-ESD in 84.6% of patients (22/26), with a median disease-free survival time of 34.5 months (IQR 19.2–56).</p> Conclusions <p>EMR-HA demonstrates clinically superior recurrence control compared to thermal ablation techniques, with extended therapeutic durability and reduced reintervention rates. The findings suggest its potential clinical utility as an endoscopic treatment option. Additionally, re-ESD provides reliable salvage for recurrent lesions.</p>

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Comparative clinical efficacy of hybrid EMR-hot avulsion versus thermal ablation for post-ESD residual margins (≤ 1 cm) in early gastric cancer: a preliminary study

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  • 发表日期：

    2025年10月31日

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  • Lei Zhang,
  • Nana An,
  • Xiuli Zheng,
  • Wenqian Ma,
  • Juntao Lu,
  • Limian Er

摘要

Background

The management of positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) to treat early gastric cancer (EGC) remains controversial. We implemented a sequential therapeutic protocol for post-ESD pLM management; this protocol involved progressing from argon plasma coagulation (APC) and hot biopsy forceps-mediated avulsion to the hybrid endoscopic mucosal resection-hot avulsion (EMR-HA) technique.

This study compared the outcomes of EMR-HA with those of thermal ablation (hot avulsion/APC) in the management of residual tumors measuring ≤ 1 cm with pLMs after gastric ESD, and both recurrence prevention and therapeutic efficacy were assessed.

Methods

In a retrospective cohort study (2015–2023) of 1,601 ESD procedures, 92 cases of pLMs with residual tumors that had maximum diameters ≤ 1 cm were analyzed. The therapeutic modalities were stratified as follows: hot avulsion (n = 25), APC (n = 41), and EMR-HA (n = 26). Statistical analyses were performed with one-way ANOVA, chi-square tests or Fisher’s exact tests, as well as Kaplan‒Meier analysis.

Results

EMR-HA resulted in a lower recurrence rate of 11.5% (3/26; median follow-up of 63 months, IQR 41–66), showing superior efficacy to both hot avulsion (44% recurrence, 11/25; P = 0.013) and APC (36.6% recurrence, 15/41; P = 0.046). The thermal ablation cohort exhibited significantly shorter median recurrence intervals (hot avulsion: 20 months; APC: 18 months) than the negative lateral margin cohort (32 months; P < 0.05). Among the 42 patients who experienced recurrence, complete resection was achieved via re-ESD in 84.6% of patients (22/26), with a median disease-free survival time of 34.5 months (IQR 19.2–56).

Conclusions

EMR-HA demonstrates clinically superior recurrence control compared to thermal ablation techniques, with extended therapeutic durability and reduced reintervention rates. The findings suggest its potential clinical utility as an endoscopic treatment option. Additionally, re-ESD provides reliable salvage for recurrent lesions.