Endoscopy 2022; 54(S 01): S284
DOI: 10.1055/s-0042-1745409
Abstracts | ESGE Days 2022
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SHORT- AND LONG-TERM OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR UNDIFFERENTIATED EARLY GASTRIC CANCER: A MULTICENTER RETROSPECTIVE COHORT

A. Papaefthymiou
1   University Hospital of Larissa, Gastroenterology, Larissa, Greece
,
M. Kahaleh
2   Robert Wood Johnson Medical Center, New Brunswick, Department of Gastroenterology, New Jersey, United States
,
K. Yamamoto
3   Japan Community Healthcare Organization Osaka Hospital, Osaka-shi, Department of Gastroenterology, Osaka, Japan
,
S. Sferrazza
4   Santa Chiara Hospital, Gastroenterology and Endoscopy Unit, Trento, Italy
,
P.H Deprez
5   Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium
,
H. Ouang
6   Hangzhou Medical College, Hangzhou, Department of Endoscopy, Zhejiang, China
,
O. Kiosow
7   University Clinic of Zaporizhzhie State Medical University, Department Multifunctional Surgery, Zaporizhzhie, Ukraine
,
G. Tribonias
8   General Hospital of Nikaia – Piraeus “Agios Panteleimon”, Gastroenterology Department, Athens, Greece
,
G.K. Patil
9   Global Hospitals, Baldota Institute of Digestive Sciences, Mumbai, India
,
D. Coumaros
10   Clinique Sainte Barbe, Department of Gastroenterology, Strasbourg, France
,
G. Mavrogenis
11   Mediterraneo Hospital, Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Athens, Greece
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Aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD). This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors.

Methods Data from 9 centers were collected retrospectively including demographics, endoscopic and pathological findings during follow-up, in 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 indepedent variables and relapse; significantly associated variables were inserted to a multivariable regression model.

Results 51 patients were eligible, with 1.5:1 female to male ratio and age of 64 (±10) years. Mean lesion size was 38.9 (±18.8)mm and the most frequent histological subtype was signet-cells UGC (64.7%). In 71.9% of cases, there were histology indicative of UD-EGC and negative imaging for advanced disease before ESD. Patients were followed-up every 3–6 months with a mean surveillance period of about 26 months. Three patients (9.4%) developed local recurrence 9 (±7.9) months after dissection, without distal metastases. Recurrence was associated with history of H.pylori infection, and poorly differentiated adenocarcinoma, submucosal, perineural and (lympho-)vascular invasion (p<0.05 per variable) but not with lesion size or other endoscopic findings. In regression analysis, perineural invasion preserved a significant association with relapses (p=0.006).

Conclusions ESD could be considered as the initial step to manage UD-EGC, providing an “entire-lesion” biopsy. Moreover, when histology confirmes absence of deep, vascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.



Publication History

Article published online:
14 April 2022

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