Endoscopic submucosal dissection of gastric superficial neoplastic lesions: a single Western center experience

Lucio Petruzziello, Mariachiara Campanale, Cristiano Spada, Riccardo Ricci, Cesare Hassan, Gaia Gullo, Guido Costamagna

Research output: Contribution to journalArticle

Abstract

Background: Endoscopic submucosal dissection (ESD) allows “en bloc” resection of superficial gastric lesions. Objective: The aim of this study is to report “en bloc" resection rate, procedure results, post resection features, analysis of complications, and relapses at mid–long term follow-up on an Italian center case series of patients with superficial gastric neoplastic lesions treated with ESD. Methods: This is a retrospective evaluation of a prospectively collected series of patients diagnosed with gastric superficial lesions who underwent ESD between November 2007 and May 2015. The analysis included demographic, clinical, endoscopic, and histological data. In detail, the following features were analyzed: (1) “en bloc” resection rate; (2) R0, R1, and RX rate; (3) complication rate; and (4) neoplastic recurrence during follow-up. A comparison was performed between lesions treated according to standard and to extended criteria. Results: In the analysis, therefore, 70 superficial lesions and 70 endoscopic procedures were considered. Overall, 53 (76%) procedures were performed according to the extended-ESD criteria. The remaining 17 (24%) cases were performed according to standard criteria. In 68/70 (97%) procedures “en bloc” resection was successful. Forty-four (65.6%) patients had a R0 resection, while 15 (22%) patients had a R1 and the remaining 8 (12.4%) patients were RX. Two patients (2.8%) experienced a major complication. Overall, 7 patients (10.4%) required surgery: in two cases because of local recurrence, in one case for an intraprocedural complication not amenable to endoscopic treatment, in three patients with R1 vertical margins, and in the last patient because of an aggressive pathology (i.e. signet ring cell adenocarcinoma). The mean follow-up of patients with neoplastic lesions was 36.6 ± 13.1 months. Conclusion: ESD for early gastric cancer is a safe and effective technique when performed by experienced Endoscopists also in Western setting. When comparing the outcomes of the ESD in patients with standard and extended indication there is no significant difference in terms of complete resection, complications and local recurrence rates. Larger Western studies are needed to clearly define the role and the outcomes of ESD in regions at low incidence for gastric neoplasia.

Original languageEnglish
Pages (from-to)203-212
Number of pages10
JournalUnited European Gastroenterology Journal
Volume6
Issue number2
DOIs
Publication statusPublished - Mar 1 2018

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Stomach
Recurrence
Endoscopic Mucosal Resection
Stomach Neoplasms
Adenocarcinoma
Demography
Pathology
Incidence

Keywords

  • Early gastric cancer
  • endoscopic submucosal dissection

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Endoscopic submucosal dissection of gastric superficial neoplastic lesions : a single Western center experience. / Petruzziello, Lucio; Campanale, Mariachiara; Spada, Cristiano; Ricci, Riccardo; Hassan, Cesare; Gullo, Gaia; Costamagna, Guido.

In: United European Gastroenterology Journal, Vol. 6, No. 2, 01.03.2018, p. 203-212.

Research output: Contribution to journalArticle

Petruzziello, Lucio ; Campanale, Mariachiara ; Spada, Cristiano ; Ricci, Riccardo ; Hassan, Cesare ; Gullo, Gaia ; Costamagna, Guido. / Endoscopic submucosal dissection of gastric superficial neoplastic lesions : a single Western center experience. In: United European Gastroenterology Journal. 2018 ; Vol. 6, No. 2. pp. 203-212.
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AU - Hassan, Cesare

AU - Gullo, Gaia

AU - Costamagna, Guido

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N2 - Background: Endoscopic submucosal dissection (ESD) allows “en bloc” resection of superficial gastric lesions. Objective: The aim of this study is to report “en bloc" resection rate, procedure results, post resection features, analysis of complications, and relapses at mid–long term follow-up on an Italian center case series of patients with superficial gastric neoplastic lesions treated with ESD. Methods: This is a retrospective evaluation of a prospectively collected series of patients diagnosed with gastric superficial lesions who underwent ESD between November 2007 and May 2015. The analysis included demographic, clinical, endoscopic, and histological data. In detail, the following features were analyzed: (1) “en bloc” resection rate; (2) R0, R1, and RX rate; (3) complication rate; and (4) neoplastic recurrence during follow-up. A comparison was performed between lesions treated according to standard and to extended criteria. Results: In the analysis, therefore, 70 superficial lesions and 70 endoscopic procedures were considered. Overall, 53 (76%) procedures were performed according to the extended-ESD criteria. The remaining 17 (24%) cases were performed according to standard criteria. In 68/70 (97%) procedures “en bloc” resection was successful. Forty-four (65.6%) patients had a R0 resection, while 15 (22%) patients had a R1 and the remaining 8 (12.4%) patients were RX. Two patients (2.8%) experienced a major complication. Overall, 7 patients (10.4%) required surgery: in two cases because of local recurrence, in one case for an intraprocedural complication not amenable to endoscopic treatment, in three patients with R1 vertical margins, and in the last patient because of an aggressive pathology (i.e. signet ring cell adenocarcinoma). The mean follow-up of patients with neoplastic lesions was 36.6 ± 13.1 months. Conclusion: ESD for early gastric cancer is a safe and effective technique when performed by experienced Endoscopists also in Western setting. When comparing the outcomes of the ESD in patients with standard and extended indication there is no significant difference in terms of complete resection, complications and local recurrence rates. Larger Western studies are needed to clearly define the role and the outcomes of ESD in regions at low incidence for gastric neoplasia.

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