Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract
- 1 January 2013
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 19 (12), 1953-61
- https://doi.org/10.3748/wjg.v19.i12.1953
Abstract
AIM: To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center. METHODS: We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ2 tests for dichotomous variables. RESULTS: Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm2. The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm2 vs 17.9 min/cm2, P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm2) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm2, P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%). CONCLUSION: ESD is an effective and safe method for resection of neoplastic lesions with low recurrence. Speed and the R0 resection rate increased after 50 proceduresKeywords
This publication has 31 references indexed in Scilit:
- Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardiaEndoscopy, 2012
- Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 expertsGastrointestinal Endoscopy, 2011
- Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in developmentEndoscopy, 2011
- Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumorsEndoscopy, 2011
- Endoscopic submucosal dissection in gastric neoplasia – experience from a European centerEndoscopy, 2010
- A lexicon for endoscopic adverse events: report of an ASGE workshopGastrointestinal Endoscopy, 2010
- A European case series of endoscopic submucosal dissection for gastric superficial lesionsGastrointestinal Endoscopy, 2009
- A multicenter retrospective study of endoscopic resection for early gastric cancerGastric Cancer, 2006
- The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002Gastrointestinal Endoscopy, 2003
- Outcomes of endoscopy procedures: Struggling towards definitionsGastrointestinal Endoscopy, 1994