Role Of Endoscopic Submucosal Dissection Research Articles

Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett's neoplasia.

The role of endoscopic submucosal dissection (ESD) in Barrett's neoplasia is ill-defined, although it might provide a higher curative resection rate and better histologic assessment than endoscopic mucosal resection (EMR). We aimed to assess efficacy, safety, and long-term results of ESD. A retrospective analysis was done of 75 consecutive patients with Barrett's esophagus who underwent ESD between January 2007 and February 2014. ESD was performed for visible lesions that were multiple, larger than 15 mm, or poorly lifting, or suspected of submucosal infiltration. The primary end point was the rate of curative resection of carcinoma. Median patient age was 68 years (interquartile range [IQR] 61 - 76), median follow-up was 20 months (IQR 8.5 - 37.5), and median maximum specimen diameter was 52.5 mm (IQR 43 - 71). En bloc resection rate was 90 % (66 /73), and rates of curative resection of carcinoma and high grade dysplasia/carcinoma were 85 % (47 /55) and 64 % (42 /66), respectively. G3 differentiation and invasion to greater than pT1m2 were observed in 25 % (14 /55) and 67 % (37 /55) of patients with adenocarcinoma, respectively. There were 5 early ( < 48 hours) adverse events (2 delayed hemorrhages and 3 perforations), all treated endoscopically. No ESD-specific death occurred. Esophageal strictures developed in 60 % of patients, all treated endoscopically. Additional treatment (median sessions 2 [IQR 2 - 3]) for residual Barrett's esophagus were recommended to 62 % (42 /68). At latest follow-up, complete remission of neoplasia and intestinal metaplasia was found in 92 % (54 /59) and 73 % (43 /59) of patients, respectively. ESD appears to be safe and effective, with a high rate of curative resection of carcinoma. ESD should be considered for patients with Barrett's neoplasia at risk of incomplete resection or poor pathologic assessment with conventional EMR.

The diagnostic role of endoscopic submucosal dissection for gastric lesions with indefinite pathology

Objective. Endoscopic forceps biopsy is a fundamental modality for the histologic diagnosis of gastric neoplasms. However, the pathologic findings are not always concordant with the endoscopic interpretations. Currently, repeat endoscopic biopsy is the only way to manage lesion of indefinite pathology such as Category 2 according to the revised Vienna classification. We aimed to elucidate the role of endoscopic submucosal dissection (ESD) in clarifying the final pathologic diagnosis. Method. Among the 2304 gastric ESD cases, a total of consecutive 30 patients with 31 lesions (1.3%) that had a forceps biopsy with indefinite pathology discrepant from the endoscopic findings underwent endoscopic submucosal dissection (ESD) for confirmative diagnosis and treatment. Results. The final pathologic diagnoses of the ESD specimens were as follows: low-grade dysplasia in 3 patients (9.7%); high-grade dysplasia in 2 patients (6.5%); adenocarcinoma in 15 patients (48.4%); and a benign lesion in 11 patients (35.5%). Cases with adenocarcinoma included nine well-differentiated lesions, four moderately differentiated lesions, and two lesions with signet ring cell carcinoma. The complete en bloc resection rate for neoplastic lesions was 95.0%, and the incidence rates of ESD-related bleeding and perforation were 5.0% and 5.0%, respectively. Conclusion. ESD can be considered an effective and safe alternative therapeutic and diagnostic tool for gastric lesions in cases where the forceps biopsy pathology is discrepant from the endoscopic findings. The overall final neoplastic diagnosis rate after ESD was 64.5%, and ESD should be performed for lesions with red coloration and friability.

Su1858 The Diagnostic Role of Endoscopic Submucosal Dissection for Gastric Lesions With Undetermined Pathology on Endoscopic Biopsy

Su1858 The Diagnostic Role of Endoscopic Submucosal Dissection for Gastric Lesions With Undetermined Pathology on Endoscopic Biopsy

Sa1550 Lower Recurrence Rate With ESD vs. EMR for the Curative Treatment of Esophageal Superficial Squamous Cell Carcinoma

The role of endoscopic submucosal dissection (ESD) in squamous cell carcinoma is still discussed in Europe with many centres proposing piecemeal EMR, although many studies from Japan showed the importance of R0 that can only be achieved by en-bloc resection with free deep and lateral margins. The aim of our study was to analyse our experience with ESD and to compare these with historical results of piecemeal EMR.

587c: ESD in Barrett's Esophagus High Grade Dysplasia and Mucosal Cancer: Prospective Comparison With CAP Mucosectomy

The role of endoscopic submucosal dissection (ESD) in high grade dysplasia (HGD) and superficial adenocarcinoma in Barrett's esophagus is not established because of the expertise needed to avoid severe complications. Many studies however showed the importance of R0 resection in upper GI superficial cancers, that can only be achieved by en-bloc resection with free deep and lateral margins. The aim of our study was to evaluate efficacy and safety of ESD compared with cap-mucosectomy (EMR-C).