Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal

Pimentel‐Nunes, Pedro; Mourão, Francisco; Veloso, Nuno; Afonso, Luís Pedro; Jacóme, Manuel; Moreira‐Dias, Luís; Dinis-Ribeiro, Mário

doi:10.1055/s-0034-1377348

Cited by 85 publications

(92 citation statements)

References 26 publications

(37 reference statements)

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“…The outcomes were similar to the results presented in the literature, with an en bloc R0 resection rate reaching 90% and a cure rate of > 80%, with a good safety profile [14, 15]. All adverse events (10.5% rate of bleeding and 0.9% rate of perforation) were controlled endoscopically and none of the patients needed surgery.…”

Section: Discussionsupporting

confidence: 84%

“…The current study represents a retrospective description of superficial epithelial gastric neoplasias treated by ESD in a single centre and the second largest Portuguese case series report published [12-14]. The outcomes were similar to the results presented in the literature, with an en bloc R0 resection rate reaching 90% and a cure rate of > 80%, with a good safety profile [14, 15].…”

Section: Discussionsupporting

confidence: 67%

“…Regardless of endoscopic treatment being less invasive and associated with better quality of life compared to surgery, preservation of the stomach carries a greater risk of other gastric cancers. Some studies report an annual incidence of 1–3% for other gastric cancers, and the cumulative incidence of MGLs constantly increased, at least during the first 3–5 years [4, 14, 23, 25]. Recently, one retrospective study showed that patients with SGLs or male patients with extensive intestinal metaplasia have a high risk of MGLs even after 5 years [25].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

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Leal

et al. 2018

GE Port J Gastroenterol

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Background: The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre. Methods: A retrospective analysis of all gastric ESDs in a tertiary specialised unit during a 5-year period, between May 2012 and September 2017, was performed. Results: A total of 114 ESDs of gastric epithelial lesions were performed during this period; 96.5% of them were removed en bloc and 87.6% with R0 resection. A curative treatment was achieved in 83.2% of the cases. Complications occurred in 13.2% of the procedures, including early and delayed bleeding in 12 patients (10.5%) and one perforation (0.9%). With a median follow-up period of 12 months (interquartile range [IQR] = 18), 6 cases of recurrence at the previous ESD site were diagnosed: 4 residual lesions and 2 local recurrences in previous R0 resections. Residual lesions occurred more often in patients with larger lesions (median = 40.0 mm, IQR = 26 vs. median = 20.0 mm, IQR = 15, p = 0.008) and with positive horizontal margins (HMs) after resection (50.0 vs. 0.0%, Fisher exact test, p < 0.001). The cumulative incidence of metachronous gastric lesions at 34 months was 16.1%. All new lesions were effectively treated using an endoscopic technique. The disease-specific survival at 12 months was 100%. Conclusion: This study showed that ESD is an effective resection technique for gastric lesions with a good safety profile, confirming other European series. Regardless, high en bloc resection positive HM is still a problem in some specimens resected by ESD. Endoscopic surveillance can detect local recurrence and new lesions during early stages, potentially treatable by endoscopy.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Costa

Ferreira

Leal

et al. 2018

GE Port J Gastroenterol

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“…The major advantages of this technique are the ability to achieve en-bloc resections allowing for an accurate tumour histopathological staging and grading with precise evaluation of resection margins, R0 resections and lower rates of local recurrence. 2,6,7 A learning curve in the performance of ESD has been demonstrated, and more experienced endoscopists have a higher rate of en-bloc resection, reduced procedure duration and fewer related adverse events. 8,9 In the East, ESD teaching has followed the traditional master-apprentice model with hands-on human cases supervised by expert endoscopists.…”

Section: Introductionmentioning

confidence: 99%

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

et al. 2018

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Introduction: Endoscopic mucosal resection and endoscopic submucosal dissection are demanding procedures. This study aims to establish face, content and expert validity of the live porcine model in performing endoscopic mucosal resection, endoscopic submucosal dissection, complication management and to assess it as a training tool. Material and methods: Tutors and trainees participating in live porcine model endoscopic mucosal resection and endoscopic submucosal dissection workshops filled out a questionnaire regarding the realism of the model compared to human setting and its role as a learning tool. A 10-point Likert scale was used. Results: Ninety-one endoscopists (13 tutors; 78 trainees) were involved in four workshops. Median global classifications for the realism of the life porcine model ranged between 7.0-8.0 (interquartile range 5.0-9.0). Procedures resembled human cases with a median of 9.0 (8.0-9.0) for oesophageal multiband endoscopic mucosal resection; 8.5 (8.0-9.0) for oesophageal endoscopic submucosal dissection; 9.0 (8.0-10.0) for gastric endoscopic submucosal dissection; and 9.0 (8.5-9.75 and 8.0-9.69) for complication detection and management. The animal model as a learning tool had median scores of 9.0 (7.0-10.0) considering how procedures are performed; 9.0-9.5 (8.0-10.0) for usefulness for beginners; and 9.0-10.0 (5.0-10.0) regarding it a prerequisite. Conclusions: Training in a live porcine model was considered very realistic compared to the human setting and was highly appreciated as a learning tool. This is the first study to establish face, content and expert validity of the live porcine model in performing multiband endoscopic mucosal resection, oesophageal and gastric endoscopic submucosal dissection. The validation of this model provides the rationale to incorporate it into formal teaching programmes.

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“…[9][10][11][12] In the last two years of experience we achieved even higher rates of R0 resection (95%).…”

Section: Discussionmentioning

confidence: 86%

Real‐life evaluation of the safety, efficacy and therapeutic outcomes of endoscopic submucosal dissection in a Western tertiary centre

et al. 2018

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Background: Endoscopic submucosal dissection (ESD) enables accurate pathological evaluation and low recurrence rates. Large series describing ESD outcomes in Western countries are scarce. Objective: To evaluate the real-life experience of ESD in a single Western centre. Methods: Data of all the patients submitted to ESD in our centre were prospectively recorded in a database, from the first procedure in 2011 until May 2017. Feasibility, en bloc and R0 resection rates and safety were assessed. Results: Three hundred and one ESDs were performed (37 in submucosal lesions) on 283 patients (54% male). Lesions were located in the oesophagus (n ¼ 13), stomach (n ¼ 169), duodenum (n ¼ 4), colon (n ¼ 35) and rectum (n ¼ 80). ESD was technically successful in 292 lesions (97%); among malignant or premalignant epithelial lesions (n ¼ 232), the en bloc resection rate was 91% and, of those, the R0 resection rate was 87% (between 69% in the colon and 93% in the stomach). Two patients needed surgery due to adverse events. Surgery for non-curative ESD was performed in 12 cases (58% without residual lesion). There were 10 perforations, 9 of them closed endoscopically. Mortality was 0%. Conclusion: Our real-life experience shows that ESD is feasible, safe and effective in Western settings. Keywords Endoscopic submucosal dissection, Western real-life experienceReceived: 4 October 2017; accepted: 1 January 2018 Key summary1. The established knowledge on this subject: . ESD is a well-established method for the treatment of gastrointestinal lesions . There are few Western referral centres for ESD and large series are scarce . ESD in some situations, as in subepithelial and non-gastric lesions, are even less reported in Western settings. 2. The significant and/or new findings of this study: . This is the biggest Western ESD series . This is the first series reporting real-life experience, from the first procedure, and including all consecutive ESDs performed in a gastroenterology department . From the early stages of implementation of ESD in a Western gastroenterology referral centre, this technique can be secure and efficient.

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Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal

Cited by 85 publications

References 26 publications

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

Real‐life evaluation of the safety, efficacy and therapeutic outcomes of endoscopic submucosal dissection in a Western tertiary centre

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