Introduction Endoscopic submucosal dissection (ESD) is an advanced technique that aims to resect appropriately selected gastrointestinal intraepithelial neoplasias en bloc, allowing precise histological diagnosis for staging and resection margin analysis. No published data from the UK exists from either tertiary referral units or DGH settings since the recent publication of ESD NICE guidelines in 2010. Such data is of paramount importance for service development and for establishing the potential role of ESD in current Cancer Service Frameworks (CSF) in the UK. Data is urgently required by NICE for stage 1 guidance revision.
Methods All patients who underwent ESD in 2009–2012 at BDGH (n = 47) were included in this study. Primary outcome measures were complication rates, resection status, 30-day readmission rates, mortality and tumour recurrence. These data were then analysed against recently published standards set by NICE.
Results Inclusions-HGD/IMC/T1 carcinoma/GIST. n = 47 (LGIT 26/UGIT 21). En bloc resection was achieved in 45/47 patients (95.7% vs 93% by NICE1). 41/46 patients had complete resection (R0) (89.1% vs 86.5% by NICE1). There were 2 cases of intra-operative bleeding (7.4% vs 22.6% by Oka S. et al), where haemostasis was achieved using triclips. There was 1 delayed bleed (2% vs 0–9% by Oka S. et al) requiring laparotomy. 1 perforation (2% vs 4% by NICE1) occurred requiring laparotomy for gastric repair. 2 patients (4%) were readmitted within 30 days post ESD - 1 with post laparotomy abdominal dehiscence, and the other with post polypectomy syndrome. There were no recurrence or metastases in our cohort (0% vs 10% by NICE1). [Median follow up 20.5 months/range 3–38 months). P > 0.5 (ns) for all parameters.
Conclusion These results represent first phase practise audit against NICE guidance. These data may enhance utilisation of ESD within the UK CSF as clear efficacy against nationally set guidelines is achievable. However, it is mandatory that ongoing multicentre efficacy data is collected. Should CSF accept this technique in full, with agreed tariff, a ‘roll out’ of a national registry and advanced training curriculum is mandatory.
Disclosure of Interest None Declared.
National Institute of Clinical Excellence IPG355/360 Endoscopic submucosal dissection (ESD) of oesophageal dysplasia and neoplasia/gastric lesions: audit support 2010. 2. Gastrointest Endosc. 2006 Dec; 64(6):877–83. Epub 2006 Sep 20. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Oka S. et al.
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