Lopes L, Giestas S, Sousa P, Parente A, Pinto F, Veiga M, Ramada J
Endoscopie – 2016-04-17 – CO –
Endoscopic submucosal dissection (ESD) is a safe and efficacious minimally invasive endoscopic therapy for the treatment of superficial gastric neoplastic lesions. In Europe, it is implemented in a minority of tertiary centers
Given its complexity, potential severe complications, and demanding learning curve, its implementation should be continuously appraised against benchmarked international quality indicators.
The objectives of this research were: (1) evaluate the efficacy and safety of ESD in the treatment of superficial gastric neoplastic lesions in a general hospital; (2) evaluate recurrence; (3) predict the ESD procedure duration.
Between September 2014 and September 2015, in a general hospital affiliated with a medical school, 11 consecutive patients with superficial gastric neoplastic lesions were submitted to ESD. The main outcomes evaluated were: technical success, complete resection (R0), adverse events and procedure duration.
73% of patients were female and mean age=69 (min 47, max, 89). The mean lesion length=29 mm (min 15, max 50); 82% of the lesions were localized at the antrum, the remaining 18 % being localized at the corpus. The mean ESD duration= 95 minutes (min 25, max 180). All resection were en-bloc, with complete resection (R0) in 82% of the patients and R1 in 18%; in the R1 patients the vertical margins were negative and the lateral margins were negative for carcinoma. Histopathology revealed 55% of patients with high-grade dysplasia and 55% with intestinal-type intramucosal adenocarcinoma. Adverse events occurred in 2 patients (late bleeding). No recurrences were detected during follow-up with scheduled endoscopic surveillance. A multiple linear regression was used to predict ESD duration; the following model was obtained: duration (min) =3,1+ 3,11x (lesion length in mm), R2=67,5% (p=0,002).
ESD is a safe and efficacious technique for the treatment of superficial gastric neoplastic lesions. The results obtained in tertiary centers are reproducible in general hospitals. The duration of the procedure could be partially predicted based on the lesion length.