Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America.

Autor:	Ngamruengphong S; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: sngamru1@jhmi.edu., Ferri L; Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada., Aihara H; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts., Draganov PV; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida., Yang DJ; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida., Perbtani YB; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida., Jue TL; Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California., Munroe CA; Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California., Boparai ES; Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California., Mehta NA; Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio., Bhatt A; Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio., Kumta NA; Division of Gastroenterology, Mount Sinai Hospital, New York, New York., Othman MO; Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas., Mercado M; Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas., Javaid H; Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas., Aadam AA; Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois., Siegel A; Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois., James TW; Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Grimm IS; Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., DeWitt JM; Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana., Novikov A; Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Schlachterman A; Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Kowalski T; Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Samarasena J; Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California., Hashimoto R; Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California., Chehade NEH; Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California., Lee J; Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California., Chang K; Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California., Su B; Department of Surgery, NorthShore University Health System, Evanston, Illinois., Ujiki MB; Department of Surgery, NorthShore University Health System, Evanston, Illinois., Mehta A; Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York., Sharaiha RZ; Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York., Carr-Locke DL; Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York., Chen A; Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada., Chen M; Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada., Chen YI; Division of Gastroenterology and Hepatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada., Pourmousavi Khoshknab M; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland., Wang R; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland., Kerdsirichairat T; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland., Tomizawa Y; Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington., von Renteln D; Division of Gastroenterology, University of Montreal Hospital Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada., Kumbhari V; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland., Khashab MA; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland., Bechara R; Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada., Karasik M; Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut., Patel NJ; Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona., Fukami N; Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona., Nishimura M; Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Hanada Y; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota., Wong Kee Song LM; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota., Laszkowska M; Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York., Wang AY; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia., Hwang JH; Department of Gastroenterology, Stanford University School of Medicine, Stanford, California., Friedland S; Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut., Sethi A; Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York., Kalloo AN; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2021 Aug; Vol. 19 (8), pp. 1611-1619.e1. Date of Electronic Publication: 2020 Jun 18.
DOI:	10.1016/j.cgh.2020.06.023
Abstrakt:	Background & Aims: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions. (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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