Endoscopic Submucosal Dissection (ESD) or Endoscopic Mucosal Resection (EMR) for Early Esophageal Cancers? Results from the Graphe Prospective Multicenter Study

Aims Esophageal cancer is associated with excellent prognosis when diagnosed and treated at an early stage. Therefore, widespread adoption of EMR and ESD is of pivotal importance but poorly assessed in routine practice. Our aim was to assess the efficacy of EMR and ESD in “real life” conditions.

Methods Patients referred for EMR or ESD of early esophageal lesions were included prospectively. Inclusion criteria were: 1) at least one macroscopic lesion with histologic confirmation of high-grade dysplasia (HGD) or carcinoma, 2) absence of previous esophageal cancer/treatment. Demographical, endoscopical, histological, and follow-up data were collected via a dedicated academic website.

Results Between February 2018 and September 2020, 74 patients from 16 centers were included. Pre-therapeutic endoscopic consisted in EUS (43 %), standard (56 %) or virtual (77 %) chromoscopy. Lesions were developed on BE or squamous mucosa in 55 % and 45 % of cases, respectively. ESD was the preferred option (81 %) versus EMR (19 %). Technical success rate was 96 %. No immediate perforation was noted. Delayed adverse events occurred in 42 % of patients (dysphagia 68 %, delayed bleeding 13 %, perforation 0 %). R0 resection rate was 63 %, but was significantly higher in BE (76 %) as compared to SCC (48 %)(p = 0.02). Resection was curative in only 46 % of patients (BE 68 % versusSCC 18 %; p < 0.001), mostly because of deep submucosal invasion. Subsequent adjuvant therapy (surgery or radiochemotherapy) was performed 31 % of patients.

Conclusions In France, ESD has become the preferred option for early esophageal lesions, with very few complications and high technical success rate. However, curative R0 occurs in 2/3 of BE patients but only in 1/5 SCC patients, mostly because of deep submucosal invasion. Whether such results are due to insufficient recognition of deep submucosal invasion signs or as an attempt to maintain “salvage” endoscopic resection as well as long-term survival outcomes remain to be determined.

Citation: Chapelle N, Barret M, Berger A et al. OP28 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) OR ENDOSCOPIC MUCOSAL RESECTION (EMR) FOR EARLY ESOPHAGEAL CANCERS? RESULTS FROM THE GRAPHE PROSPECTIVE MULTICENTER STUDY. Endoscopy 2021; 53: S15.

Publication History

Article published online:
19 March 2021