OUTCOMES OF GASTRIC ESD IN A EUROPEAN CENTRE – WHAT WE HAVE DONE IN 11 YEARS

Aims:

Endoscopic submucosal dissection (ESD) was recently recommended as a first-line treatment in patients with gastric superficial neoplasms, although experience with this technique is still limited in Western countries. We aimed to evaluate the outcomes of this technique since the introduction of this technique in our centre.

Methods:

Retrospective analysis of a prospectively maintained database of consecutive patients with gastric superficial neoplasms scheduled for gastric ESD during a 11-year period.

Results:

During the study period, 347 gastric ESDs were completed and 6 were considered non-feasible. The majority of the lesions were located in the lower third of the stomach (51.3%) and Paris 0-II (91.5%, with 45.5% exhibiting a depressed component (0-IIc), and had a mean size of 19.4 mm (SD 10.3); median procedural time was 75 minutes (IQR 55 – 120). Intra-procedural adverse events (AEs) occurred in 1.2% (4 cases – 2 perforations and 2 major bleedings), and post-procedural bleeding occurred in 7.5%. Major adverse events requiring surgery occurred in 0.6% (1 case of delayed perforation and 1 of major bleeding). The resection was en-bloc in 95.1% and complete histological resection (R0) was achieved in 92.2%. The most frequent pathology was intramucosal neoplasia (62.7%), and the resection was considered curative in 81.8% (81% standard criteria and 19% expanded criteria); histological upgrade occurred in 85.5%. Local recurrence occurred in 2.0%, the majority being amenable for further endoscopic treatment.

Conclusions:

We present a large cohort of gastric ESD in an european centre, demonstrating its effectiveness and safety in this setting. Short-term outcomes are comparable from those of Eastern countries. Training and dissemination of endoscopic resection for gastric neoplasms should be disseminated.