1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes

Takashi Toyonaga, Mariko Man-i, James E East, Eisei Nishino, Wataru Ono, Tomoomi Hirooka, Chie Ueda, Yoshinori Iwata, Takeshi Sugiyama, Toshio Dozaiku, Takashi Hirooka, Tsuyoshi Fujita, Hideto Inokuchi, Takeshi Azuma, Takashi Toyonaga, Mariko Man-i, James E East, Eisei Nishino, Wataru Ono, Tomoomi Hirooka, Chie Ueda, Yoshinori Iwata, Takeshi Sugiyama, Toshio Dozaiku, Takashi Hirooka, Tsuyoshi Fujita, Hideto Inokuchi, Takeshi Azuma

Abstract

Background: Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasms; however, most ESD articles report small series, with short-term outcomes performed by multiple operators on single organ. We assessed short- and long-term treatment outcomes following ESD for early neoplasms throughout the gastrointestinal tract.

Methods: We performed a longitudinal cohort study in single tertiary care referral center. A total of 1,635 early gastrointestinal neoplasms (stomach 1,136; esophagus 138; colorectum 361) were treated by ESD by single operator. Outcomes were complication rates, en bloc R0 resection rates, and long-term overall and disease-specific survival rates at 3 and 5 years for both guideline and expanded criteria for ESD.

Results: En bloc R0 resection rates were: stomach: 97.1 %; esophagus: 95.7 %; colorectum: 98.3 %. Postoperative bleeding and perforation rates respectively were: stomach: 3.6 and 1.8 %; esophagus: 0 and 0 %; colorectum: 1.7 and 1.9 %. Intra criteria resection rates were: stomach: 84.9 %; esophagus: 81.2 %; colorectum: 88.6 %. Three-year survival rates for lesions meeting Japanese ESD guideline/expanded criteria were for all organ-combined: 93.4/92.7 %. Five-year rates were: stomach: 88.1/84.6 %; esophagus: 81.6/57.3 %; colorectum: 94.3/100 %. Median follow-up period was 53.4 (range, 0.07-98.6) months. Follow-up rate was 94 % (1,020/1,085). There was no recurrence or disease-related death.

Conclusions: In this large series by single operator, ESD was associated with high curative resection rates and low complication rates across the gastrointestinal tract. Disease-specific and overall long-term prognosis for patients with lesions within intra criteria after curative resection appeared to be excellent.

Figures

Fig. 1
Fig. 1
Survival curves following ESD, split into guideline criteria, expanded criteria, and multiple lesions, organs combined
Fig. 2
Fig. 2
Survival curves following ESD, split into guideline criteria, expanded criteria, and multiple lesions, stomach
Fig. 3
Fig. 3
Survival curves following ESD, split into guideline criteria, expanded criteria, and multiple lesions, esophagus
Fig. 4
Fig. 4
Survival curves following ESD, split into guideline criteria, expanded criteria, and multiple lesions, colorectum

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Source: PubMed

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