Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry

Abstract

Introduction: Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives:To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods:The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en-bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed.Results: Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty-eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60-150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45-121] vs. 110 min [62-160]; p = 0.038). En-bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability wereThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries: a systematic review and meta-analysis

“…The main characteristics of the 27 studies [ 8 - 11 , 18 - 40 ] are summarized in Table 1 . Nineteen (n=1344) were cohorts and 8 (n=531) case series.…”

Endoscopic Treatment of Superficial Gastric Cancer: Present Status and Future

“…While many countries with a high prevalence of H. pylori infection could greatly benefit from a screening program for GC, issues such as cost, medical insurance, and other social and economic problems must be overcome to implement a screening program on a national or global level. As for the implementation of ESD in countries with a low incidence of GC, while it has been reported that ESD could be safely and usefully performed in Western countries, the establishment of training methods is also an issue [ 58 ]. ESGE guidelines recommend performing at least 10 ESD procedures under expert supervision and 25 ESD procedures per year to maintain ESD performance [ 42 ].…”

Gastric submucosal mass lesions

“…Modifications to the standard ESD technique may allow for resection of the muscle layer as well. En bloc resection allows for complete histologic assessment and may provide a complete and curative resection [10 ▪▪ ,25 ▪▪ ,26 ▪ ]. There are an increasing number of western studies, which have looked at adaptation of this technique with promising results [27 ▪ –29 ▪ ].…”