S1615 Clinical Outcome of Endoscopic Submucosal Dissection for Early Gastric Cancer: A Retrospective Single Center Study

Abstract

Introduction: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer without the risk of lymph node metastasis. However, the outcomes in the United States are not well studied because of the low prevalence of gastric cancer. We aimed to assess the efficacy and safety of ESD for early gastric cancer in the United States. Methods: We performed a single-center retrospective analysis of patients who underwent gastric ESD between June 2018 and December 2021. The main outcome measures were en-bloc resection rate, R0 (complete) resection rate, procedure time, tumor size, hospital length of stay (LOS), histology, and complication rate. Results: In total, 46 patients were included (Table). The median age was 71 years (range, 68.9-76.8 years). En-bloc and R0 resection rates were 94.5% and 81.8%, respectively. The median procedure time was 87.5 min (range, 69.3-118.8 min). The median tumor size was 26mm (range, 20-35 mm). The mean hospital length of stay was 1.87±1.38 days. The most common histologic type was pT1a (45.7%), followed by pT1b (26.1%), adenoma with low-grade dysplasia (13.0%), adenoma with high-grade dysplasia (10.9%), and neuroendocrine tumor (4.3%). There were 3 adverse events all of which were delayed bleeding and no perforations were reported. Conclusion: Our study showed that gastric ESD is a safe and effective method for superficial gastric neoplasia. ESD should be considered for patients with suitable lesions in the U.S. Table 1. - Baseline Characteristics and Outcomes of Gastric Endoscopic Submucosal Dissection ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal dissection; LGD, low-grade dysplasia; HGD, high-grade dysplasia Baseline characteristics Age, y, median (IQR) 71 (68.9-76.8) Sex, men/women, n 30/16 ASA class, n (%) Ⅰ 0 0 II 0 0 Ⅲ 5 10.9 Ⅳ 41 89.1 Lesion site, n (%) Antrum 10 21.7 Body 13 28.3 Greater curvature 1 2.2 Lesser curvature 5 10.9 Cardia 12 26.1 Incisura angularis 5 10.9 Type of injection, n (%) Eleview 11 23.9 Orise 35 76.1 Type of primary knife for ESD, n (%) Dual knife 29 63.0 ProKnife 17 37.0 Anesthesia, n (%) Propofol 7 15.2 General anesthesia 39 84.8 Interventions before ESD, n (%) Tattoo underneath lesion 6 13.0 Scar underneath lesion 10 21.7 Radiofrequency ablation 1 2.2 ESD 4 8.7 EMR 4 8.7 Outcomes En bloc resection, n (%) 43 93.5 R0 resection, n (%) 36 78.3 Procedure time, min, median (IQR) 87.5 (69.3 - 118.8) Tumor size, mm, median (IQR) 26 (20 - 35) Length of hospital stay, d, mean ± SD 1.8 ± 1.4 Histology, n (%) Adenoma with LGD 6 13.0 Adenoma with HGD 5 10.9 pT1a 21 45.7 pT1b 12 26.1 Neuroendocrine tumor 2 4.3 Adverse event, n (%) Delayed bleeding 3 6.5 Perforation 3 6.5 Infection 0 0