Endoscopy 2020; 52(S 01): S225
DOI: 10.1055/s-0040-1704702
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 14:30 – 15:00 Upper GI: Endoscopic cancer treatment 1 ePoster Podium 1
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC NEOPLASIA FOLLOWING ABSOLUTE AND EXPANDED INDICATION CRITERIA. OUTCOMES FROM A PROSPECTIVE WESTERN COHORT

Spanish Endoscopic Resection Working Group of the Spanish Society of Digestive Endoscopy (Endoscopic Resection GSEED)
JS Garcia
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
D De Frutos Rosa
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
BA Castillo
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
L De la Corte
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
MGH Ruiz
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
C González-Lois
2   Puerta de Hierro University Hospital, Pathology, Majadahonda, Spain
,
BT Lanseros
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
I Omella
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
A Martinez
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
R González
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
,
AH de Tejada Echanojauregui
1   Puerta de Hierro University Hospital, Gastroenterology, Majadahonda, Spain
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Publikationsverlauf

Publikationsdatum:
23. April 2020 (online)

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    Aims To compare outcomes of gastric endoscopic submucosal dissection (ESD) following absolute (AC) and expanded criteria (EC) indication.

    Methods All gastric lesions meeting AC or EC treated by ESD between January 2012 and November 2019 in a single tertiary center were included. Subepithelial lesions, non-neoplastic epithelial lesions and neoplastic epithelial lesions not meeting AC or EC were excluded.

    Results 35 lesions in 34 patients were included. Lesions most frequently appeared in men (60%), mean age 70.3 (SD8.4). Predominant location was antrum (42.9%) followed by incisura (25.7%). Mean size was 25,2 mm (SD14.8).

    AC comprised 29 (82.8%) of the indications. En-bloc resection rate was 96.6% for the AC and 100% for the EC (p = 0.656). Complete resection rate was lower for the EC: 89.7% vs 66.7% (p = 0.151). The curative resection rate was significantly higher for the AC group: 89.7% vs 33.3% (p = 0.001). 3/29 cases in the AC group did not achieve the curative criteria: 1 HGD with lateral-margin affected and 2 pT1b well-differentiated adenocarcinoma with deep-margin involvement (one showed additional lymphovascular invasion). ESD was not curative for 4/6 cases from EC: 2 poorly-differentiated adenocarcinoma with size > 2 cm and 2 pT1b well-differentiated adenocarcinoma with deep-margin involvement.

    Complication rate was 31.7% in the AC group vs 0% in EC with only 2 cases requiring surgical treatment.

    The median follow-up for patients meeting curative criteria was 16.1 months (IQR = 30.7). No local or distant recurrences were identified in this cohort.

    All patients meeting non-curative criteria underwent surgery. 1 (33.3%) patient in the AC group presented residual HGD whereas the other 2 showed no residual disease. For the EC group, all cases (4, 100%) showed a free-of-neoplasia surgical specimen.

    Conclusions EC was associated with a significantly lower curative resection rate in our series. However this was not correlated with a higher recurrence rate or the presence of residual disease in the surgical specimen.


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