Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study.

Raffaele Manta,Francesco P Zito,Angelo Zullo,Francesco Pugliese,Giuseppe Galloro,Riccardo Marmo,Rita Conigliaro,Massimiliano Mutignani,Stefano Angeletti,Angelo Caruso,Santi Mangiafico,Bruno Annibale,Gianluca Esposito

doi:10.3390/jcm9030737

Abstract

Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no need for surgical treatment) for EGC. The incidence of complications, the one-month mortality, and the recurrence rate at one-year follow-up were computed. A total of 296 patients with 299 gastric lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5% (58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were treated with radiological embolization (1 case) or surgery (1 case). No procedure-related deaths at one-month follow-up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and 10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low and amenable at endoscopy.

Highlights

The possibility of removing early neoplastic lesions on gastric mucosa by endoscopic submucosal dissection (ESD) is a definite advantage for both patients and health resources utilization [1]
This multicenter study aimed to evaluate the results of the ESD procedure for gastric lesion removal in Italy, in terms of technical success, clinical outcome, and complications
Endoscopic, histological, and clinical data of consecutive patients who underwent gastric ESD were gathered in an electronic database, which were anonymously analyzed as aggregate data for the center

Summary

Introduction

The possibility of removing early neoplastic lesions on gastric mucosa by endoscopic submucosal dissection (ESD) is a definite advantage for both patients and health resources utilization [1]. This procedure allows treatment of early gastric cancer (EGC) and non-invasive neoplasia—i.e., low- and high-grade dysplasia. First introduced in Japan twenty years ago, the use of the ESD technique, in removing gastric lesions, is still limited in Western countries [3]. This multicenter study aimed to evaluate the results of the ESD procedure for gastric lesion removal in Italy, in terms of technical success, clinical outcome, and complications

Methods

Results

Discussion

Conclusion