Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry.

Published on Jun 2, 2021in United European gastroenterology journal3.549
· DOI :10.1002/UEG2.12101
Gloria Fernández-Esparrach33
Estimated H-index: 33
(University of Barcelona),
JC Marín-Gabriel2
Estimated H-index: 2
(Complutense University of Madrid)
+ 12 Authorsen representación del grupo de Dse de la Seed
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) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en-bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. RESULTS Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty-eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60-150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45-121] vs. 110 min [62-160]; p = 0.038). En-bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1-11.74 and OR 5.07, 95%CI 1.6-16.08; respectively). CONCLUSIONS Although the number of cases is limited, the results of this analysis show acceptable en-bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD.
#1Eduardo AlbénizH-Index: 8
#2Antonio Z. Gimeno-García (Hospital Universitario de Canarias)H-Index: 22
Last. Mónica EnguitaH-Index: 1
view all 47 authors...
Abstract Background and Aims The Endoscopic Resection Group model (GSEED-RE) and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after endoscopic mucosal resection (EMR) of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. Methods A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of...
12 CitationsSource
#1Miguel Araújo-Martins (University of Porto)H-Index: 2
Last. Mário Dinis-RibeiroH-Index: 57
view all 5 authors...
Background and Study Aim Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries.
4 CitationsSource
#1Eduardo AlbénizH-Index: 8
Last. Mónica Enguita-Germán (Universidad Pública de Navarra)H-Index: 1
view all 20 authors...
Abstract Background & Aims It is not clear whether closure of mucosal defects with clips after colonic endoscopic mucosal resection (EMR) prevents delayed bleeding, although it seems to have no protective effects when risk is low. We performed a randomized trial to evaluate the efficacy of complete clip closure of large (≥2 cm) large nonpedunculated colorectal lesions (LNPCLs) after EMR in patients with an estimated average or high risk of delayed bleeding Methods We performed a single-blind tri...
41 CitationsSource
#1David J. Tate (USYD: University of Sydney)H-Index: 12
#2Amir Klein (Westmead Hospital)H-Index: 14
Last. Michael J. Bourke (USYD: University of Sydney)H-Index: 57
view all 9 authors...
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 West...
17 CitationsSource
#1Pedro Pimentel-Nunes (University of Porto)H-Index: 27
#2Mathieu PiocheH-Index: 17
Last. Raf Bisschops (Katholieke Universiteit Leuven)H-Index: 47
view all 18 authors...
There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training. Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD training ESGE discou...
27 CitationsSource
#1F. CatalanoH-Index: 10
#2Valentina Mengardo (University of Verona)H-Index: 4
Last. G. De Manzoni (University of Verona)H-Index: 25
view all 8 authors...
Endoscopic submucosal dissection (ESD) represents the standard of care for early gastric cancer in Eastern countries. Nevertheless, in the West, this procedure is not widespread. Aim of the study was to confirm the feasibility and the efficacy of ESD in the West. A total of 60 ESD were performed between January 2005 and December 2014 by two expert endoscopists. The analysis, based on a retrospective collected database, was conducted by dividing the study period in three subgroups. Clinical and t...
7 CitationsSource
#1Diogo Libânio (Instituto Português de Oncologia Francisco Gentil)H-Index: 16
#2Vânia Braga (Instituto Português de Oncologia Francisco Gentil)H-Index: 2
Last. Pedro Pimentel-Nunes (Instituto Português de Oncologia Francisco Gentil)H-Index: 27
view all 10 authors...
Background There are no prospective studies comparing endoscopic submucosal dissection (ESD) and gastrectomy, especially evaluating patient-reported outcomes. Our aim was to compare the safety and impact on quality of life (QoL) of ESD and gastrectomy in patients with early gastric neoplasia. Methods This prospective study included consecutive patients presenting with early gastric neoplasia in a tertiary center from January 2015 to August 2016. Data collection included curative resection, adver...
12 CitationsSource
#1Dane Christina Daoud (UdeM: Université de Montréal)H-Index: 1
#2Nicolas Suter (UdeM: Université de Montréal)H-Index: 2
Last. Daniel von Renteln (UdeM: Université de Montréal)H-Index: 18
view all 6 authors...
Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis
24 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
#1Ji Ha Kim (PNU: Pusan National University)H-Index: 1
#2Hyeong Seok Nam (PNU: Pusan National University)H-Index: 9
Last. Si Hak Lee (PNU: Pusan National University)H-Index: 5
view all 9 authors...
Background and study aim Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.
26 CitationsSource
Cited By0