Introduction Gastric endoscopic submucosal dissection (ESD) is a technique developed in the East but its adoption in the West has been slow to take off due to the relatively higher risk of complications including bleeding and perforation. The aim of this study was to analyse the efficacy and safety data when this technique was used in a single large UK tertiary referral centre.
Method A prospectively compiled database of all gastric ESDs carried out in a large tertiary referral centre between 2009 and 2017 was reviewed by two independent researchers. All gastric ESDs in our institution were discussed in a specialist MDT prior to resection. Post-resection histology were reviewed in the same MDT and further management decisions were made based on consensus.
Results A total of 50 gastric ESDs were performed during the study period by a single operator. The mean age of patients was 73 years and 31 were male. Lesion characteristics are as shown in Table 1.
The en-bloc resection rate was 90% (45/50 patients). 16% had scarring due to previous resections (8/50 patients). Histological assessment was carried out for all patients apart from 1 where the lesion was not retrieved. Of the lesions retrieved 51% of the lesions contained cancer, 33% contained dysplasia, 12% hyperplastic, 2% carcinoid and 2% GIST. R0 resection rate was 71.4% which includes 6 patients with known submucosal (SM) invasion that underwent salvage ESD as they were not fit for curative surgery. The overall rate of complications in this series was 12% (5 bleeding, 1 perforation – all managed endoscopically). The median length of follow-up was 11 months. Recurrence was detected in 3 patients and all these patients were managed with further endoscopic resection.
Conclusion Gastric ESD is a safe and effective technique in managing gastric neoplasia in a UK setting.The R0 resection rates for curative resection are high and complication rates are low. Gastric ESD should be considered a viable treatment option for early gastric neoplasia in the UK.
Disclosure of Interest K. Kandiah: None Declared, S Subramaniam: None Declared, P Bhandari Conflict with: Receives educational grants from Fujifilm, Olympus and Pentax
- gastric cancer