Introduction Endoscopic Submucosal Dissection (ESD) is an established treatment of early gastrointestinal neoplasia in Japan. It carries a greater risk of complications than conventional EMR. Use and experience of ESD in the west is limited with most centres having only performed small numbers of cases. We aim to evaluate the outcomes of ESD service in our centre.
Methods Upper and Lower Gastrointestinal Endoscopic Resections database was evaluated to identify patients who underwent ESD and their demographics, histology, techniques, complications and outcomes were analysed.
Results Upper Gastrointestinal: 25 ESD were performed in 23 patients between 2006 and 2011 (11 males). Mean age was 61.5 years. 14/25 involved en bloc ESD (where a circumferential incision is made to remove the whole lesion) and 11/25 involved a hybrid technique (where a circumferential incision is made followed by resection using a snare). 2/25 perforations occurred, both managed with endoscopic clips requiring no surgical intervention. 22/25 procedures were completed successfully. In 2/25, lesions were unable to be fully resected and 1/25 was abandoned due to perforation. Due to advanced histology, four proceeded to radical or palliative treatment. Colonic: 66 patients underwent ESD between 2006 and 2011 (21 males). Mean age was 68.5 years. 43/66 had enbloc ESD and 13/66 a hybrid procedure. 14/66 was in the right colon and 52/66 in the left colon. 24 lesions were LST-G, 8 were LST-NG and six were unspecified LST. Bleeding occurred in four cases (three delayed) all treated endosopically. Perforation occurred in four cases, only one required surgery and the rest ere managed with endoscopic clips. 4/66 had incomplete primary resection (one had perforation requiring surgery). 4/66 had recurrence requiring further sessions. 2/66 patients required curative surgery due to advanced histology.
Conclusion (1) ESD service is feasible, safe and effective in a UK setting. (2) Our data demonstrates that ESD can be used to treat a wide variety of lesions through out the gut. (3) Perforation remains a significant risk but effective clipping technique can avoid the need for surgery. (4) ESD should be centralised to high volume expert centres to achieve good outcomes and establish training programmes.
Competing interests None declared.
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