Endoscopy 2010; 42(10): 814-819
DOI: 10.1055/s-0030-1255778
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection for gastric lesions: results of an European inquiry

F.  Ribeiro-Mourão1 , P.  Pimentel-Nunes2 , 3 , M.  Dinis-Ribeiro1 , 2
  • 1CINTESIS/Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Porto, Portugal
  • 2Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
  • 3Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
Further Information

Publication History

submitted 8 May 2010

accepted after revision 23 August 2010

Publication Date:
30 September 2010 (online)

Background and study aims: In Japanese centers, endoscopic submucosal dissection (ESD) is commonly used for the resection of early gastric lesions. However, in Europe, only a few reports have been published. The aim of the current study was to survey the current use of ESD by European endoscopists.

Methods: Between April and May 2009, European endoscopists (n = 490) who had articles published in the journals Endoscopy and/or Gastrointestinal Endoscopy during 2007 and 2008 were asked to complete an online questionnaire.

Results: A total of 58 endoscopists completed the questionnaire (12 %). Only 20 centers performed ESD, which was mostly performed by a single endoscopist in each center. Each endoscopist had treated a mean of four cases during the previous year (mean total experience 11 ESDs) bringing a total of 510 ESDs across all European centers that responded (197 during the past year). Lesions were located in the antrum in 35 % of cases; 39 % were Paris classification IIa, 22 % IIa + b, and 18 % IIa + c. Overall, the average of mean lesion diameter was 15.7 mm (range 1 – 70.0 mm). Most cases were non-invasive high-grade intraepithelial neoplasia (44 %) or adenocarcinoma (36 %). An insulated-tipped knife (1 or 2) was used in 70 % of procedures and an average of the mean duration of procedures was 108 minutes. In all, 78 % of lesions were removed en bloc with an R0 rate of 77 %. Endoscopists experienced major complications (perforation or major bleeding) in 13 % of cases.

Conclusion: ESD in Europe seems to be performed at a few centers, with most endoscopists performing a low number of procedures, achieving a high rate of efficacy and a moderate rate of major complications. However, as a potential selection bias may have occurred, multicenter registries should be conducted to help address the problem of dissemination of this technique.

References

  • 1 Black R J, Bray F, Ferlay J, Parkin D M. Cancer incidence and mortality in the European Union: cancer registry data and estimates of national incidence for 1990.  Eur J Cancer. 1997;  33 1075-1107
  • 2 Pinheiro P S, Tyczynski J E, Bray F. et al . Cancer incidence and mortality in Portugal.  Eur J Cancer. 2003;  39 2507-2520
  • 3 Ferlay J, Autier P, Boniol M. et al . Estimates of the cancer incidence and mortality in Europe in 2006.  Ann Oncol. 2007;  18 581-592
  • 4 Gossner L. The role of endoscopic resection and ablation therapy for early lesions.  Best Pract Res Clin Gastroenterol. 2006;  20 867-876
  • 5 Gotoda T, Yamamoto H, Soetikno R M. Endoscopic submucosal dissection of early gastric cancer.  J Gastroenterol. 2006;  41 929-942
  • 6 Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection.  Gastrointest Endosc Clin N Am. 2007;  17 441-469, v
  • 7 Cao Y, Liao C, Tan A. et al . Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract.  Endoscopy. 2009;  41 751-757
  • 8 Esaki M, Matsumoto T, Hirakawa K. et al . Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection.  Endoscopy. 2007;  39 41-45
  • 9 Nakamoto S, Sakai Y, Kasanuki J. et al . Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection.  Endoscopy. 2009;  41 746-750
  • 10 Watanabe K, Ogata S, Kawazoe S. et al . Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection.  Gastrointest Endosc. 2006;  63 776-782
  • 11 Gotoda T. Endoscopic resection of early gastric cancer.  Gastric Cancer. 2007;  10 1-11
  • 12 Deprez P, Aouattah T, Chun-Ping R. et al . Endoscopic resection of superficial gastric tumors [abstract].  Gastrointest Endosc. 2007;  65 AB164
  • 13 Deprez P, Sempoux C, Jouret-Mourin A. et al . Endoscopic management of ESD and EMR perforations (abstract).  Endoscopy. 2008;  40 A171
  • 14 Pimentel-Nunes P, Dinis-Ribeiro M, Santos L. et al . Endoscopic submucosal dissection for gastric superficial lesions is also feasible in Europe (abstract).  Endoscopy. 2009;  41 A214
  • 15 Probst A, Arnholdt H, Anthuber M. et al . Endoscopic submucosal dissection (ESD) of large mucosal and submucosal lesions in the GI tract: experience in the Western world [abstract].  Gastrointest Endosc. 2007;  65 AB268
  • 16 Probst A, Golger D, Pommer B. et al . Endoscopic submucosal dissection (ESD) of large mucosal and submucosal lesions in the GI tract – experience in the Western world (abstract).  Endoscopy. 2009;  41 A542
  • 17 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M. et al . A European case series of endoscopic submucosal dissection for gastric superficial lesions.  Gastrointest Endosc. 2009;  69 350-355
  • 18 Neuhaus H, Costamagna G, Deviere J. et al . Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the ”R-scope”).  Endoscopy. 2006;  38 1016-1023
  • 19 Bergman J J. How to justify endoscopic submucosal dissection in the Western world.  Endoscopy. 2009;  41 988-990
  • 20 Choi I J, Kim C G, Chang H J. et al . The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm.  Gastrointest Endosc. 2005;  62 860-865
  • 21 Kakushima N, Fujishiro M, Kodashima S. et al . A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms.  Endoscopy. 2006;  38 991-995
  • 22 Yamamoto S, Uedo N, Ishihara R. et al . Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve.  Endoscopy. 2009;  41 923-928

M. Dinis-RibeiroMD, PhD 

Gastroenterology Department
Portuguese Oncology Institute of Porto

Rua Dr. Bernardino de Almeida
4200-072 Porto
Portugal

Fax: +351-22-5084055

Email: mario@med.up.pt