Outcomes and safety of endoscopic submucosa dissection at a university clinic in Austria

Introduction Endoscopic submucosa dissection (ESD) has evolved to an excellent treatment option for early carcinomas in the upper and the lower gastrointestinal tract as well as for large lateral spreading tumors (LST) of the colorectal area and is often preferred to surgery.

Methods In this retrospective analysis we included all ESD procedures performed at Kepler University hospital from March 2020 until May 2021. Before each ESD a second look endoscopy was performed to check on the feasibility of the procedure. We analysed the rate of successful ESDs, en bloc resections and short-term complications within seven days. Furthermore we checked if the procedure was curative and the rate of carcinomas in the resection specimens.

Results In total, 53 ESDs were performed during the observational interval. The mean age of patients was 64 years (range 38-84). 18 ESDs were performed in the oesophagus (both barret´s and squamous epithelial), 10 ESDs in the stomach, 23 in the rectum and 2 in the colon.Overall, the success rate was 94 % (50/53) and the en bloc resection rate was 87 % (46/53). Complications happened four times. One perforation (2 %) with the need for acute surgery and three delayed bleedings (6 %) with sufficient endoscopic bleeding control. The need for stopping the procedure was two times (4 %) because of deep submucosal invasion.

Regarding the established histologic criteria, the rate of curative ESDs was 76 % (40/53). In eleven cases (21 %) surgery after the ESD was indicated. The rate of carcinomas was 49 % (26/53).

Conclusion ESD is a safe and effective procedure for treating LST and early carcinomas in the gastrointestinal tract but should only be performed in centres with enough cases and expertise. In comparison to published literature the outcome and safety of the procedure at Kepler University hospital is comparable.

Publication History

Article published online:
01 September 2021