Tu1484 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION OF EARLY GASTRIC NEOPLASIA IN THE WEST: RESULTS FROM FOUR TERTIARY REFERRAL EUROPEAN CENTRES

Abstract

Endoscopic submucosal dissection (ESD) is a technique first developed in Japan to enable en-bloc endoscopic resection of early gastric neoplasia. The high prevalence of gastric neoplasia allowed for greater opportunity to train and refine the technique in the Far East. The same is not applicable to the West where the prevalence of gastric neoplasia is low. We aim to review the efficacy and safety of ESD for early gastric neoplasia from four large European referral centres. Data was prospectively collected on an electronic database. We analysed this database and patient’s electronic record. Parameters related to ESD outcome were collected. Data was analysed using SPSS software with logistic regression and multivariate analysis. A total of 264 gastric neoplasia lesions were resected between 2009 and 2019 (233 ESD, 31 hybrid ESD). Mean age was 72.0 years (range 38-91), and 150 patients were males (56.8%). 149 lesions (56.4%) were in proximal stomach. Mean size was 28.4mm (range 4-130mm). Mean duration of follow up is 8.2 months. Resection histology showed adenocarcinoma in 149 (56.7%) of cases, 21 (14.1%) of these were poorly differentiated. The overall en-bloc resection, R0, and recurrence rates were 93.5%, 83.3%, and 5.3%, respectively. Table (1) shows procedure-related complications, and table (2) summarizes predictors for R1 outcome. These included proximal location (OR 5.27, P=0.009), poor differentiation (OR 8.49, P=0.006), and LVI (OR 8.73, P= 0.007). There was no 30-day procedure related mortality. This is the largest western gastric ESD series, demonstrating the feasibility and safety of this technique in a European setting. Despite the relatively low R0 rate, our recurrence rate is low and comparable to Japanese data. Reasons behind good clinical outcome (low recurrence) despite average technical outcome (R0) remains uncertain.This raises a possibility that in the west, R-1 should not automatically be considered as an indication for surgery.Table (2)Multi-variate analysis showing predictors of outcomes (R1, recurrence) following gastric ESD in four European centres (N=264).View Large Image Figure ViewerDownload Hi-res image Download (PPT)