Effectiveness, Safety and Feasibility of Endoscopic Submucosal Dissection: A Prospective Western Experience Looking To East

Aims Endoscopic submucosal dissection (ESD) allows en-bloc resection of superficial gastrointestinal neoplasms, which has implications for complete excision, recurrence and pathological analysis. This study aimed to assess the effectiveness, safety and feasibility of ESD as a treatment for gastrointestinal lesions in a western cohort.

Methods All consecutive patients undergoing ESD at one Italian tertiary referral center were prospectively enrolled from September 2018 to March 2020. Primary outcomes were en-bloc resection rate, R0 resection rate and adverse events rate.

Results One hundred and eleven patients (65.8 % males, median age 70.9 years) with 111 lesions undergoing ESD were included in the study. Among these, 86/111 (77.5 %) were managed as inpatients, 25/111 (22.5 %) as outpatients. Overall, 63/111 lesions (56.8 %) were located in the rectum, 15/111 (13.5 %) in the colon, 27/111 (24.3 %) in the stomach and 6/111 (5.4 %) in the esophagus. The mean lesion size was 36.7 mm (range 15-82 mm).

En bloc resection was achieved in all but one case (99.1 %). R0 resection was achieved in 95/111 patients (85.6 %): 55/63 for rectal (87.3 %), 12/15 for colonic (80 %), 23/27 for gastric (85.2 %) and 5/6 for esophageal lesions (83.3 %). The overall curative resection rate was 82.0 %. Median procedure time was 95 minutes (IQR 75-120). Major adverse events were observed in 12 cases (10.8 %): 5 cases of intraprocedural perforations (4.5 %), 6 post-procedural bleeding (5.4 %) and one case of transient urinary retention. All luminal adverse events were treated endoscopically. After a median follow-up of 9.1 months (range 3-25.5), only one case of recurrence, radically treated with cold EMR, was registered.

Conclusions Our experience confirms that ESD is an effective, safe and feasible treatment for early gastrointestinal neoplasia and that Asian’s standards can also be obtained in Western endoscopy units. Therefore, also in Western countries, ESD should be considered as a therapeutic option for lesions that require an ‘en-bloc’ resection.

Citation: sferrazza s, Maida M, Fuccio L et al. eP13 EFFECTIVENESS, SAFETY AND FEASIBILITY OF ENDOSCOPIC SUBMUCOSAL DISSECTION: A PROSPECTIVE WESTERN EXPERIENCE LOOKING TO EAST. Endoscopy 2021; 53: S101.

Publication History

Article published online:
19 March 2021