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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(07): E673-E678
DOI: 10.1055/a-2105-1934
Original article

Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort

Apostolis Papaefthymiou 
1   Endoscopy Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
Michel Kahaleh 
2   Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States (Ringgold ID: RIN43982)
,
Arnaud Lemmers
3   Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
,
Sandro Sferrazza
4   Department of Gastroenterology and Digestive Endoscopy, APSS Trento, Trento, Italy
,
Maximilien Barret 
5   Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, France (Ringgold ID: RIN26935)
,
Katsumi Yamamoto 
6   Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
,
Pierre Deprez
7   Cliniques Universitaires St-Luc, Université Catholique de Louvain, Louvain Medical ASBL, Bruxelles, Belgium (Ringgold ID: RIN572042)
,
José C. Marín-Gabriel 
8   Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
,
George Tribonias 
9   Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece (Ringgold ID: RIN69067)
,
Hong Ouyang
10   Endoscopy, The People's Hospital of Linan City, hangzhou, China
,
Federico Barbaro
11   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy (Ringgold ID: RIN18654)
,
Oleksandr Kiosov 
12   University Clinical, Zaporizhzhia State Medical University, Zaporozhye, Ukraine (Ringgold ID: RIN430799)
,
Stefan Seewald
13   Center for Gastroenterology, Hirlanden Clinic Zurich, Zurich, Switzerland
,
Gaurav Patil
14   BIDS, Global Hospitals Mumbai, Mumbai, India (Ringgold ID: RIN483146)
,
Shaimaa Elkholy 
15   Gastroenterology Division, Internal Medicine Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (Ringgold ID: RIN63527)
,
Dimitri Coumaros
16   Gastroenterology Department, Clinique Sainte Barbe, Strasbourg, France
,
Clemence Vuckovic
17   Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
,
Matthew Banks
18   Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
Rehan Haidry
19   Gastroenterology, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN9687)
,
Georgios Mavrogenis
20   Gastroenterology, Mediterraneo Hospital, Athens, Greece (Ringgold ID: RIN168211)
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Abstract

Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors.

Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model.

Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence (P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence (P = 0.006 and P < 0.001, respectively).

Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an “entire-lesion” biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Upper GI Tract

Supporting information



Publication History

Received: 19 January 2023

Accepted after revision: 31 May 2023

Accepted Manuscript online:
02 June 2023

Article published online:
26 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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