Introduction Endoscopic Resection (ER), a technique, first pioneered in Japan for treating early gastric cancers, has gained popularity globally. The delivery of an ER service requires specialist expertise and is therefore limited to a few centres in the UK. Here in Bradford, an ER service was established in 2007, and is delivered by a single operator. The aim of this study was to observe changes in our ER practice over time.
Methods This was a prospective study of all patients who had undergone ER between August 2007 and December 2012 in Bradford Royal Infirmary. Patients were referred by experienced consultants, from the same trust or neighbouring hospitals, and were considered difficult cases, due to lesion size and/or access. Data from every ER case were recorded into a spreadsheet and divided into upper gastrointestinal (GI) ER or lower GI ER. We recorded patient demographics, lesion size and site, sedation, outcome, complications, and lesion removal (whole/piecemeal). Cases performed before 2010 (pre-2010) were separated from those performed in or after 2010 (post-2010). Data were analysed separately for the 2 time periods and then compared.
Results There were a total of 245 ER cases over the study period (47 upper GI, and 198 lower GI).
The number of upper GI ER cases increased from 15, pre-2010 to 32, post-2010. The success rate improved over time from 87 to 97% and the complication rate fell from 26 to 6%. Complications included 1 gastric perforation and 5 cases of minor bleeding treated endoscopically. The mean doses of Midazolam (2.5 mg) and Fentanyl (30 mcg) remained the same over time; however cases performed under general anaesthesia (GA) increased sharply from 7% to 37%. Mean polyp size also increased from 14 to 18 mm, although the distribution of polyps in the upper GI tract remained the same over time, with around 50% found in the stomach. Whole piece removal increased from 53% to 66%, despite increasing polyp size.
The number of lower GI ER cases also increased substantially from 62, pre-2010, to 136, post-2010. Success rate improved from 92 to 95%, whilst the complication rate remained the same at 5%. Complications included 1 postpolypectomy syndrome and 6 cases of bleeding. Doses of Midazolam (1.5 mg) and Fentanyl (75 mcg) remained the same over time, and interestingly the use of GA in lower GI ER was considerably lower (<1%) compared to upper GI cases. There were no changes in polyp size (26 mm), polyp distribution or whole piece removal (40%) over time.
Conclusion Our results demonstrate an increasing use of ER for upper and lower GI lesions. Over time, and thus, with more experience the success rate and complication rate have improved. These results are in line with other studies, emphasising ER as a safe technique, which should be considered before surgery for managing large and difficult GI lesions.
Disclosure of Interest None Declared.
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