Carola Fleischmann1, Andreas Probst1, Alanna Ebigbo1, Siegbert Faiss2, Brigitte Schumacher3, H-P Allgaier4, F L Dumoulin5, Ingo Steinbrueck6, Michael Anzinger7, Joerg Marienhagen8, Anna Muzalyova9, Helmut Messmann10. 1. Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany. 2. Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany. 3. Department of Gastroenterology, Elisabeth-Krankenhaus Essen, Essen, Germany. 4. Medical Department, Evangelisches Diakoniekrankenhaus, Freiburg, Germany. 5. Department of Medicine/Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany. 6. Department of Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany. 7. Department of Gastroenterology, Barmherzige Brüder Krankenhaus München, München, Germany. 8. Faculty of Medicine, University of Augsburg, Augsburg, Germany. 9. Chair of Health Care Operations/ Health Information Management, UNIKA-T, University of Augsburg, Augsburg, Germany. 10. Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany. Electronic address: helmut.messmann@uk-augsburg.de.
Abstract
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD. METHODS: The German ESD registry is a prospective uncontrolled multicenter study. During a 35-month period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤20 ESDs/y), middle-volume (20-50/y), and high-volume centers (>50/y). A multivariate analysis investigating risk factors for noncurative resection was performed. RESULTS: Overall, en bloc, R0, and curative resection rates of 92.4% (95% confidence interval [CI], 0.90-0.94), 78.8% (95% CI, 0.76-0.81), and 72.3% (95% CI, 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI, 0.067-0.102), whereas the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, and recurrence rates and lower complication rates than middle- or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for noncurative ESD. CONCLUSION: In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center's yearly case volume.
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD. METHODS: The German ESD registry is a prospective uncontrolled multicenter study. During a 35-month period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤20 ESDs/y), middle-volume (20-50/y), and high-volume centers (>50/y). A multivariate analysis investigating risk factors for noncurative resection was performed. RESULTS: Overall, en bloc, R0, and curative resection rates of 92.4% (95% confidence interval [CI], 0.90-0.94), 78.8% (95% CI, 0.76-0.81), and 72.3% (95% CI, 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI, 0.067-0.102), whereas the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, and recurrence rates and lower complication rates than middle- or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for noncurative ESD. CONCLUSION: In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center's yearly case volume.
Authors: Dennis Yang; Hiroyuki Aihara; Muhammad K Hasan; Cem Simsek; Hafiz Khan; Tony S Brar; Venkata S Gorrepati; Justin J Forde; Kambiz Kadkhodayan; Mustafa A Arain; Peter V Draganov Journal: DEN open Date: 2022-10-10