Endoscopic submucosal dissection for suspected early gastric cancer: absolute versus expanded criteria in a large Western cohort (with video).

Published on Sep 1, 2019in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2019.04.242
David J. Tate12
Estimated H-index: 12
(USYD: University of Sydney),
Amir Klein14
Estimated H-index: 14
(Westmead Hospital)
+ 6 AuthorsMichael J. Bourke57
Estimated H-index: 57
(USYD: University of Sydney)
Sources
Abstract
Background and Aims Endoscopic submucosal dissection (ESD) is an effective, minimally invasive, surgery-sparing technique for the treatment of early gastric cancer (EGC). It is not well established whether EGC within the Japanese expanded criteria can be safely and effectively treated using ESD in the West. We describe the outcomes of ESD for endoscopically suspected, biopsy specimen–confirmed EGC and its adenomatous precursor lesions (pEGC) using the Vienna classification of dysplasia in a Western cohort. Methods Prospective data were collected on all pEGCs undergoing ESD at a single expert endoscopy center. Outcomes were compared among pEGC, satisfying the Japanese absolute and expanded criteria, those outside criteria, and those specimens that contained low-grade dysplasia (LGD) only. Specialist GI pathologists reviewed and classified all ESD specimens. Patients were followed up at 6 and 12 months. Results Over 71 months, 135 pEGCs in 121 patients (mean age, 72.0 years; 61.2% men) underwent ESD. Median pEGC size was 20 mm (interquartile range, 15-30), and 62 (45.9%) satisfied the expanded clinical criteria. Perforation occurred in 1.5% and postprocedural bleeding in 5.2%. Forty-two pEGCs (31.1%) contained LGD only. Rates of en bloc and R0 resection were 94.8% and 86.7%, respectively. One hundred seven pEGCs (79.2%) met the absolute or expanded criteria for endoscopic cure. Two pEGCs recurred during follow-up. Ten of 26 patients with pEGC (38.5%) outside criteria for cure underwent surgery after ESD with residual tumor detected in 3 specimens. Fifteen patients with outside criteria for pEGCs did not undergo surgery because of frailty or their expressed wish. Eleven of 15 patients have so far undergone first surveillance with 1 of 11 experiencing endoscopic and histologic recurrence. Conclusions ESD is a safe and effective treatment for pEGCs in a Western context. Patients who either decline or are too frail for surgery, with outside criteria resections, may benefit from ESD for local disease control. Large Western studies of ESD for pEGCs are required to define long-term patient outcomes and surveillance guidelines, particularly where pathology shows LGD or high-grade dysplasia only. (Clinical trial registration number: NCT02306707.)
📖 Papers frequently viewed together
1 Citations
2 Citations
References27
Newest
#1Michael X. MaH-Index: 4
#2Michael J. Bourke (USYD: University of Sydney)H-Index: 57
: Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in...
34 CitationsSource
#1Michael J. Bourke (USYD: University of Sydney)H-Index: 57
#2Horst NeuhausH-Index: 41
Last. Jacques J. BergmanH-Index: 67
view all 3 authors...
Endoscopic submucosal dissection was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. Previously, the majority of these patients were treated surgically at substantial cost and with significant risk of short- and long-term morbidity. En-bloc excision of these early cancers, most with a limited risk of nodal metastasis, allowed complete staging...
40 CitationsSource
#1David J. Tate (USYD: University of Sydney)H-Index: 12
#2Farzan F. Bahin (USYD: University of Sydney)H-Index: 15
Last. Michael J. Bourke (USYD: University of Sydney)H-Index: 57
view all 6 authors...
Background and aims Non-lifting large laterally spreading colorectal lesions (LSLs) are challenging to resect endoscopically and often necessitate surgery. A safe, simple technique to treat non-lifting LSLs endoscopically with robust long-term outcomes has not been described. Methods In this single-center prospective observational study of consecutive patients referred for endoscopic mucosal resection (EMR) of LSLs ≥ 20 mm, LSLs not completely resectable by snare because of non-lifting underwent...
35 CitationsSource
#1Mi Young Jeon (Yonsei University)H-Index: 7
#2Jun Chul Park (Yonsei University)H-Index: 24
Last. Yong Chan Lee (Yonsei University)H-Index: 48
view all 6 authors...
Background and Aims We aimed to evaluate long-term outcomes with noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and surveillance strategies such as the optimal time for additional endoscopic treatment in patients with noncurative ESD. Methods Of 2527 patients who underwent gastric ESD for EGC, 512 (20.3%) patients with noncurative resection were reviewed. Noncurative resection is defined as positive resected margins on histology, lymphovascular infiltration, or...
23 CitationsSource
#1Mihai Ciocirlan (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 8
2 CitationsSource
#1Andreas Probst (Augsburg College)H-Index: 15
#2Annette Schneider (Augsburg College)H-Index: 2
Last. Helmut Messmann (Augsburg College)H-Index: 53
view all 6 authors...
Background and study aims Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) fulfilling guideline resection criteria or the expanded resection criteria in Asia. It is unclear whether the expanded criteria can be transferred to European patients, and long-term follow-up data are lacking. The aim of this study was to evaluate long-term follow-up data after ESD of EGCs in Europe. Patients and methods Patients with EGC who underwent ESD were included in t...
52 CitationsSource
#1Dong Woo Shin (KNU: Kyungpook National University)H-Index: 1
#2Hee Young Hwang (KNU: Kyungpook National University)H-Index: 2
Last. Seong Woo Jeon (KNU: Kyungpook National University)H-Index: 30
view all 3 authors...
Abstract Endoscopic submucosal dissection (ESD) is a novel alternative treatment for differentiated early gastric cancer (EGC) without lymph node metastasis. We conducted this study to verify the therapeutic usefulness of ESD for treating differentiated EGC compared to that of surgery. This is a retrospective cohort study of 382 patients treated with differentiated EGC from March 2006 to May 2010. The propensity score yielded 275 matched patients. They were divided into an ESD group of 175 peopl...
23 CitationsSource
#1Satoshi Tanabe (Kitasato University)H-Index: 32
#2Kenji Ishido (Kitasato University)H-Index: 17
Last. Yoshikazu Yoshifuku (Hiroshima University)H-Index: 11
view all 19 authors...
Objective The indications for endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC) have been expanded. However, the long-term outcomes of ESD remain unclear. We retrospectively investigated the long-term outcomes of ESD in patients with EGC.
49 CitationsSource
#1Maximilien Barret (Paris V: Paris Descartes University)H-Index: 19
#2Vincent LepilliezH-Index: 18
Last. Frédéric Prat (Paris V: Paris Descartes University)H-Index: 17
view all 26 authors...
IntroductionEarly reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time.Material and methodsAll consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over...
25 CitationsSource
#1Ko Watanabe (Fukushima Medical University)H-Index: 11
#2Takuto Hikichi (Fukushima Medical University)H-Index: 16
Last. Hiromasa Ohira (Fukushima Medical University)H-Index: 30
view all 13 authors...
Background and study aims The safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in very elderly patients remains unclear. The aim of this study was to evaluate the safety and efficacy of ESD for EGC in patients age 85 years and older. Patients and methods Patients who underwent ESD for EGC between September 2003 and April 2015 were divided into 3 groups: the very elderly (≥ 85 years; 43 patients), the elderly (65 – 84 years; 511 patients), and the non-e...
8 CitationsSource
Cited By17
Newest
#1Edward Young (Lyell McEwin Hospital)H-Index: 1
#1Edward YoungH-Index: 1
Last. Rajvinder SinghH-Index: 30
view all 0 authors...
Source
#1Saowanee Ngamruengphong (Johns Hopkins University)H-Index: 31
#1Saowanee Ngamruengphong (Johns Hopkins University)H-Index: 1
Last. A. N. Kalloo (Johns Hopkins University)H-Index: 10
view all 56 authors...
ABSTRACT Background & Aims Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related ...
5 CitationsSource
#1Vitor Arantes (ALFA)H-Index: 9
#2J. Aliaga Ramos (UPCH: Cayetano Heredia University)
view all 3 authors...
Resumen Introduccion y objetivos La diseccion endoscopica de submucosa (ESD) en el tratamiento de las neoplasias superficiales del tracto gastrointestinal es uno de los mas grandes avances en endoscopia terapeutica en la actualidad. En America Latina aun no se utiliza de manera rutinaria debido a la alta complejidad tecnica. El objetivo de este estudio es presentar la experiencia con ESD en neoplasias gastricas superficiales desarrollada en Brasil a partir del entrenamiento con expertos japonese...
Source
#1Vitor Arantes (ALFA)H-Index: 9
#2J. Aliaga Ramos (UPCH: Cayetano Heredia University)
Last. Moisés Salgado PedrosaH-Index: 6
view all 3 authors...
Resumen null null Introduccion y objetivos null La diseccion endoscopica de submucosa (ESD) en el tratamiento de las neoplasias superficiales del tracto gastrointestinal es uno de los mas grandes avances en endoscopia terapeutica en la actualidad. En America Latina aun no se utiliza de manera rutinaria debido a la alta complejidad tecnica. El objetivo de este estudio es presentar la experiencia con ESD en neoplasias gastricas superficiales desarrollada en Brasil a partir del entrenamiento con ex...
Source
#1Mohamed Barakat (Brooklyn Hospital Center)H-Index: 6
#2Daryl Ramai (Brooklyn Hospital Center)H-Index: 9
Last. Douglas G. Adler (UofU: University of Utah)H-Index: 65
view all 7 authors...
Background and study aims The goal of this study was to assess surgical resection (SR) of early gastric cancer (EGC) fitting Japanese Gastric Cancer Association (JGCA) endoscopic resection (ER) criteria. Patients and methods We analyzed EGC data from the national Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Results A total of 2219 EGC cases were identified (1074 T1a and 1145 T1b). Of them, 409 met absolute criteria, 219 met expanded 1, 529 expanded 2, and 229 ex...
1 CitationsSource
#1Gloria Fernández-Esparrach (University of Barcelona)H-Index: 33
#2JC Marín-Gabriel (Complutense University of Madrid)H-Index: 2
view all 15 authors...
INTRODUCTION Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. OBJECTIVES To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. PATIENTS AND METHODS The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qua...
Source
#1Linda S. Yang (University of Melbourne)H-Index: 1
#2Andrew C.F. Taylor (University of Melbourne)H-Index: 16
Last. Bronte A. Holt (University of Melbourne)H-Index: 4
view all 5 authors...
Background and aims Endoscopic submucosal dissection (ESD) is the recommended treatment for early gastric cancer (EGC). However, there are challenges in attaining expertise in ESD in countries where the incidence of gastric cancer, and proportion diagnosed at an early stage of disease is relatively low. This study aims to establish the proportion of gastric cancer meeting histological criteria for EGC which may be suitable for ESD, in a Western population. Methods Gastric cancers reported to the...
Source
#1Paul Doumbe-Mandengue (University of Paris)
#2Frédéric BeuvonH-Index: 23
Last. Maximilien Barret (University of Paris)H-Index: 19
view all 14 authors...
OBJECTIVES Adenocarcinomas of the esophagus and of the gastric cardia are regarded as a same clinical entity in oncology. For endoscopic resection however, endoscopic mucosal resection is recommended for esophageal adenocarcinoma, while endoscopic submucosal dissection (ESD) is advocated for gastric adenocarcinomas. Our aim was to compare the outcomes of ESD in both types of esophagogastric junction adenocarcinomas. METHODS Between March 2015 and December 2019, we included all patients who under...
Source
#1Ting Fan (Nanjing Medical University)H-Index: 1
#2Qi Sun (NU: Nanjing University)H-Index: 10
Last. Guifang Xu (NU: Nanjing University)H-Index: 17
view all 12 authors...
Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. The number of the patients in the ab...
Source
#1Inês Pita (Instituto Português de Oncologia Francisco Gentil)H-Index: 7
#2Diogo Libânio (Instituto Português de Oncologia Francisco Gentil)H-Index: 16
Last. Pedro Pimentel Nunes (Instituto Português de Oncologia Francisco Gentil)
view all 3 authors...
Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer risk and guidelines recommend endoscopic surveillance, as diagnosis of early gastric neoplasia allows endoscopic resection. This review summarizes the current approach to the diagnosis and surveillance of pre-malignant gastric conditions and endoscopic treatment of early gastric cancer. Virtual chromoendoscopy can diagnose extensive gastric metaplasia with great accuracy compared with histopathology an...
Source