ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR GASTRIC LESIONS: A SINGLE ITALIAN CENTER EXPERIENCE

Aims The aim of this study is to report the short- and long-term outcomes of a cohort of patients from a single Italian center who underwent gastric ESD.

Methods A retrospective analysis of a prospectively mantained registry of all gastric ESDs performed at Humanitas Research Hospital during a 10-year period (January 2010 – January 2019) was performed. Expanded indication criteria for gastric ESD were used.

Results During the study period, 158 consecutive gastric lesions were treated by ESD. On final pathology, 91 lesions were adenocarcinoma (57.4%) with a subclassification of pT1a: 56 (61.5%), pT1b: 31 (34.%) and pT2: 4 (4.4%). Thirty-eight lesions were diagnosed as high grade dysplasia (24.%), 23 were low grade dysplasia only (14.5.%) and 6 were non-adenomatous (3.8%). An en-bloc resection was achieved in 136 patients (86%). R0 resection was reported in 116 patients (73,4%), while 30 yielded a R1 resection (19%) and the remaining 12 procedures (7.6%) were classified as Rx. Twenty-two patients (14%) experienced a complication (11 early, 10 delayed, 1 both early and delayed). The most common complication was bleeding (17 patients, 10.7%) while 5 perforations (3%) were reported. All these complications were successfully treated endoscopically except 3 patients who required surgery. No deaths occurred related to the ESD procedure.

Overall, 23 patients (14.5%) underwent surgery because of non-curative resections. Thirteen patients (8.2) were lost at follow-up. Mean follow-up was 37.2 months (range 122–3). During follow-up, 6 local recurrences of adenoma with LGD at the previous ESD site were diagnosed while 2 patients developed a cancer in a site different from ESD and were referred to surgery.

Conclusions In a large western series of ESD for early gastric neoplasia ESD was associated with a significant proportion of curative resection and quite low rate of complications as well as disease recurrence.