The feasibility and safety of endoscopic submucosal dissection of gastric lesions larger than 5cm.

Abstract

As the indications for endoscopic submucosal dissection (ESD) for early gastric cancer have been revised, diagnostic ESD has increased. However, despite the technical difficulty of ESD for large lesions, the degree to which curative resection can be achieved has not been clarified. This study investigated the feasibility and safety of ESD for gastric lesions larger than 5cm. This retrospective multicenter study included 3474 gastric lesions treated by ESD from April 2012 to December 2021. We compared clinicopathological characteristics and treatment outcomes between lesions ≥ 5cm and lesions < 5cm. There were 128 lesions in the ≥ 5cm group and 3282 lesions in the < 5cm group. In the ≥ 5cm group, upper location and fibrosis during ESD were more common, with a lower rate of 0-IIc type. Both en bloc resection rate and R0 resection rate were comparable, but there was a difference in curative resection rate (65.6% in the ≥ 5cm group and 91.5% in the < 5cm group). The frequency of adverse events (post-ESD bleeding, perforation, or stenosis) was almost similar, but delayed perforation was significantly more common (1.6% in the ≥ 5cm group vs. 0.1% in the < 5cm group). About two-thirds of curative resections were obtained with ESD for early gastric lesions larger than 5cm, but delayed complications should be noted (Number: UMIN000047725).