Abstract:Objective To investigate the efficacy and differences between endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early colorectal cancer and precancerous lesions. Methods A retrospective analysis was conducted on the clinical information of 655 patients who underwent endoscopic treatment for intestinal lesions at the Department of Gastroenterology, Jiangning Hospital, Nanjing, from January 2020 to May 2024, with postoperative pathology indicating early colorectal cancer or high-grade intraepithelial neoplasia. The efficacy was analyzed by grouping according to surgical method and lesion morphology. Results EMR has been shown to suitable for lesions with a diameter ≤2 cm and protruding lesions, while ESD has been shown to suitable for lesions with a diameter ＞2 cm and laterally spreading lesion. The incidence of intraoperative complications in the ESD group was significantly higher than that in the EMR group ［21.5% (55/256) vs 7.5%(30/399), χ²=26.933, P＜0.01］. For Is-type, Isp-type and Ip-type of protruded lesions, the incidence of intraoperative complications of ESD was significantly higher than that of EMR（P<0.01）, but the curative resection rates and postoperative complication rates had no statistical significance between ESD and EMR treatment (P>0.05). For Ip-type lesions, the overall hospital stay was significantly shorted with EMR treatment (P＜0.05). There was no significant difference in curative resection rates for Is-type, Isp-type, and Ip-type lesions treated with EMR (P＞0.05), but the proportion of Ip-type lesions with a diameter ＞2 cm was significantly higher than that of Is-type and Isp-type lesions (P＜0.05). Conclusion Both EMR and ESD have their advantages in the treatment of early colorectal cancer and precancerous lesions, but for Ip-type lesions with larger diameters, EMR treatment is safe and effective.