Saowanee Ngamruengphong1, Lorenzo Ferri2, Hiroyuki Aihara3, Peter V Draganov4, Dennis J Yang4, Yaseen B Perbtani4, Terry L Jue5, Craig A Munroe5, Eshandeep S Boparai5, Neal A Mehta6, Amit Bhatt6, Nikhil A Kumta7, Mohamed O Othman8, Michael Mercado8, Huma Javaid8, Abdul Aziz Aadam9, Amanda Siegel9, Theodore W James10, Ian S Grimm10, John M DeWitt11, Aleksey Novikov12, Alexander Schlachterman12, Thomas Kowalski12, Jason Samarasena13, Rintaro Hashimoto13, Nabil El Hage Chehade13, John Lee13, Kenneth Chang13, Bailey Su14, Michael B Ujiki14, Amit Mehta15, Reem Z Sharaiha15, David L Carr-Locke15, Alex Chen2, Michael Chen2, Yen-I Chen16, MirMilad Pourmousavi Khoshknab17, Rui Wang17, Tossapol Kerdsirichairat17, Yutaka Tomizawa18, Daniel von Renteln19, Vivek Kumbhari17, Mouen A Khashab17, Robert Bechara20, Michael Karasik21, Neej J Patel22, Norio Fukami22, Makoto Nishimura23, Yuri Hanada24, Louis M Wong Kee Song24, Monika Laszkowska25, Andrew Y Wang26, Joo Ha Hwang27, Shai Friedland21, Amrita Sethi25, Antony N Kalloo17. 1. Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: sngamru1@jhmi.edu. 2. Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. 3. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts. 4. Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida. 5. Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California. 6. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio. 7. Division of Gastroenterology, Mount Sinai Hospital, New York, New York. 8. Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas. 9. Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois. 10. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 11. Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana. 12. Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 13. Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California. 14. Department of Surgery, NorthShore University Health System, Evanston, Illinois. 15. Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York. 16. Division of Gastroenterology and Hepatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. 17. Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland. 18. Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington. 19. Division of Gastroenterology, University of Montreal Hospital Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada. 20. Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada. 21. Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut. 22. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona. 23. Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 24. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 25. Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York. 26. Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia. 27. Department of Gastroenterology, Stanford University School of Medicine, Stanford, California.
Abstract
BACKGROUND & AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. METHODS: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. RESULTS: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. CONCLUSIONS: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
BACKGROUND & AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. METHODS: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. RESULTS: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. CONCLUSIONS: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
Authors: Fernando Palacios-Salas; Harold Benites-Goñi; Luis Marin-Calderón; Paulo Bardalez-Cruz; Jorge Vásquez-Quiroga; Edgar Alva-Alva; Bryan Medina-Morales; Jairo Asencios-Cusihuallpa Journal: Clin Endosc Date: 2021-11-12
Authors: Elettra Merola; Andrea Michielan; Umberto Rozzanigo; Marco Erini; Sandro Sferrazza; Stefano Marcucci; Chiara Sartori; Chiara Trentin; Giovanni de Pretis; Franca Chierichetti Journal: World J Gastrointest Surg Date: 2022-02-27
Authors: Maria Rinzivillo; Francesco Panzuto; Gianluca Esposito; Edith Lahner; Alberto Signore; Bruno Annibale Journal: J Clin Med Date: 2022-03-16 Impact factor: 4.241