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

Abstract

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.

Pathologic evaluation of endoscopically resected non-ampullary duodenal lesions: a single center experience

“…, and concluded that duodenal ESD is useful for larger (>20 mm) lesions (21). As for the West, the contribution to the literature is relatively recent: only a handful of duodenal ERs were reported recently (22)(23)(24), yet series with comparable sizes (i.e. n=166 duodenal ERs in Pérez-Cuadrado-Robles et al's study) are being published from specialized referral centers (25,26).…”

“…n=166 duodenal ERs in Pérez-Cuadrado-Robles et al's study) are being published from specialized referral centers (25,26). The main reason for this is that, similar to other sites of the gastrointestinal tract, the western experience with duodenal ESD and EMR was limited compared to the Far East (22)(23)(24)(27)(28)(29)(30)(31)(32), due to flat learning curve of these techniques and lack of training facilities for the endoscopists in the west (17,(33)(34)(35). In fact, as reported by Yamamoto et al, even in Japan where these procedures were developed and mastered, duodenal ESDs are performed in only a few institutions, due to the high risk of complications (19).…”

Submucosal Cancer in Granular Mixed Type Laterally Spreading Tumors: Is Universal ESD an Acceptable Approach in These Lesions?

“…in all rectal lesions that cannot be resected in 1 fragment by snare, to always have en bloc resection in this area. This strategy is based on our large experience with ESD, very good outcomes, 2 and a high rate of malignant lesions in the rectum (nearly 25%). 3 The authors 1 reported 278 rectal lesions, with a high rate of SMIC (n ¼ 42; 15%).…”

Evolution of endoscopic resection for early esophageal squamous cell carcinoma in Western countries

“…However, Western experience of ESD remains scarce owing to the lower incidence of esophageal SCC and the lesser capability of using ESD to treat early disease and dysplastic lesions than in Eastern countries. Santos-Antunes et al reported adequate curative resection rates in the biggest Western ESD series; nevertheless this still included only a small number of patients with esophageal tumors [4]. Thus, in Western countries accumulation of data with larger cohorts is needed regarding the feasibility of ESD for esophageal SCC.…”