Endoscopy 2015; 47(09): 775-783
DOI: 10.1055/s-0034-1391844
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study

Yoshiki Tsujii
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Tsutomu Nishida
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Osamu Nishiyama
2   Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan
,
Katsumi Yamamoto
3   Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
,
Naoki Kawai
4   Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
,
Shinjiro Yamaguchi
4   Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
,
Takuya Yamada
5   Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan
,
Toshiyuki Yoshio
5   Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan
,
Shinji Kitamura
6   Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan
,
Takeshi Nakamura
7   Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan
,
Akihiro Nishihara
8   Department of Gastroenterology, Minoh City Hospital, Minoh, Japan
,
Hideharu Ogiyama
9   Department of Gastroenterology, Itami City Hospital, Itami, Japan
,
Masanori Nakahara
10   Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
,
Masato Komori
11   Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan
,
Motohiko Kato
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Yoshito Hayashi
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Shinichiro Shinzaki
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Hideki Iijima
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Tomoki Michida
12   Department of Gastroenterology, Osaka Kosei-nenkin Hospital, Osaka, Japan
,
Masahiko Tsujii
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Tetsuo Takehara
1   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
› Author Affiliations
Further Information

Publication History

submitted 16 April 2014

accepted after revision 30 January 2015

Publication Date:
31 March 2015 (online)

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Background and study aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals.

Patients and methods: Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed.

Results: The median tumor size was 18 mm (range 2 – 85 mm). The median procedure time was 90 minutes (range 12 – 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % – 98.1 %) and 84.5 % (95 %CI 80.5 % – 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % – 7.9 %), 1.6 % (95 %CI 0.7 % – 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % – 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 – 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections.

Conclusions: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

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