INITIAL EXPERIENCE OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN BRAZIL TO TREAT EARLY GASTRIC AND ESOPHAGHEAL CANCER: a multi-institutional analysis

Chaves, Dalton Marques; Moura, Eduardo Guimarães Hourneaux de; Milhomem, Daniela; Arantes, Vitor; Yamazaki, K.; Maluf, Fauze; Albuquerque, Walton; Conrado, Antonio Carlos; Araujo, Júlia; Uejo, Paula H S; Sakai, Paulo

doi:10.1590/s0004-28032013000200025

Cited by 21 publications

(9 citation statements)

References 13 publications

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“…Long-term outcomes are rarely described. Nevertheless, all the authors have concluded that esophageal ESD is feasible, and rates of complete resection and complications were not significantly different from Eastern series [16,24,28,33,38,40]. For the stomach the scenario is similar.…”

Section: Appendix 3 Training In Endoscopic Submucosal Dissection !mentioning

confidence: 92%

“…Inexperience in ESD might not only be associated with higher risk for procedure-related complications, but also with the risk of incomplete resection [219]. For these reasons ESD has been restricted to tertiary referral centers, although a multicenter retrospective questionnaire study showed that outcomes of ESD for early gastric neoplasms at low volume centers were as good as those at high volume centers [33,220]. Farhat et al reported that with increased endoscopist experience the duration of ESD diminished significantly for the same relative size of lesions.…”

Section: Appendix 3 Training In Endoscopic Submucosal Dissection !mentioning

confidence: 99%

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Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2015

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1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). \ud \ud 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). \ud \ud 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10-15mmwith a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). \ud \ud 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence)

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Section: Appendix 3 Training In Endoscopic Submucosal Dissection !mentioning

confidence: 92%

Section: Appendix 3 Training In Endoscopic Submucosal Dissection !mentioning

confidence: 99%

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2015

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“…From the oncological perspective it has been suggested that ESD techniques are equally effective in comparison to surgical treatment for superficial neoplasms with negligible risk of lymph node metastasis (2,3) . Moreover, ESD application has been expanded on a worldwide basis and is progressively attracting attention and acceptance (6)(7)(8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Is Endoscopic Submucosal Dissection Still Limited to Few Tertiary Centers in the West? Results From a National Survey in Brazil

Arantes

Sanna

Alves

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

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“…As it was initially proposed, EMR consists of a minimally invasive technique used for diagnosis, staging and treatment of superficial tumors, including the sessile polyps of the gastrointestinal mucosa (7) . In contrast, ESD results in relatively large en bloc resections, allowing lower rates of local tumor recurrence and better pathological assessment (2,8) . Although these surgical procedures have emerged as important therapeutic modalities for superficial tumors of the gastrointestinal mucosa, they are not widespread yet, inasmuch as they are highly dependant on the endoscopist's expertise.…”

mentioning

confidence: 99%

Superficial tumors of the gastrointestinal mucosa: the problem of the histological diagnosis of intravascular infiltration in tissues from endoscopic submucosal dissection

Barbosa

2013

J. Bras. Patol. Med. Lab.

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INITIAL EXPERIENCE OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN BRAZIL TO TREAT EARLY GASTRIC AND ESOPHAGHEAL CANCER: a multi-institutional analysis

Cited by 21 publications

References 13 publications

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Is Endoscopic Submucosal Dissection Still Limited to Few Tertiary Centers in the West? Results From a National Survey in Brazil

Superficial tumors of the gastrointestinal mucosa: the problem of the histological diagnosis of intravascular infiltration in tissues from endoscopic submucosal dissection

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