ENDOSCOPIC SUBMUCOSAL DISSECTION OF UPPER AND LOWER GASTROINTESTINAL LESIONS IN A SINGLE WESTERN CENTER: A DESCRIPTIVE, STEP-UP APPROACH

Aims: Background Endoscopic submucosal dissection has been adopted in Asia and Europe. However, there is lack of data on its implementation and usefulness in the United States.

Aims To evaluate the development of ESD in the United States by analyzing the steps of implementation, technique and outcomes.

Methods Retrospective, single-center cohort study reviewing all cases in which gastrointestinal ESD was used. All procedures were performed by one therapeutic endoscopist. The following information was collected: experience of endoscopist, type of training, process of implementation, location of the lesion, indication, procedure time, and instruments used, submucosal injection solutions, adverse events.

Results A total of 72 ESD procedures were performed during a 2-year period. The lesions treated by ESD were located in the esophagus (n = 7, Barrett neoplasia n = 3 early squamous cell cancer n = 4), stomach (n = 21, early stomach cancer n = 5, adenoma n = 8, submucosal tumors n = 6, other n = 4), duodenum (n = 6, adenoma n = 4, carcinoid n = 2), colon n=38. The mean lesion size was 32,25mm (SD ±3,35 mm, range 10-200 mm). En bloc resection was achieved in 91,7%, with complete R0 resection in 84,7%. The median ESD procedure time was 57,35±3,16 min (range 25-120). The most frequent instruments used included the needle (hook) knife (66,7%), IT knife in 33,3%. Complications included bleeding in 9 cases (12,5%) (5 intraporcedural, 4 post-procedure, only 1 requiring blood transfusion, and 1 perforation (1,4%) (treated with clip and over-the-scope clip, respectively).

Conclusions A structured approach to implementation and use of ESD in a USA center demonstrated that ESD was safe and efficient, reflecting current experience of other large centers in Europe and initial experience in Japan and Korea.