Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry.

Autor: Fernández-Esparrach G; Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain., Marín-Gabriel JC; Endoscopy Unit, Gastroenterology Department, 'i+12 Research Institute', Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain., de Tejada AH; Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain., Albéniz E; Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain., Nogales O; Hospital Gregorio Marañón, Marañón, Madrid, Spain., Del Pozo-García AJ; Endoscopy Unit, Gastroenterology Department, 'i+12 Research Institute', Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain., Rosón PJ; Hospital Quirón, Málaga, Spain., Goicotxea U; Hospital Universitario de Donostia, San Sebastián, Spain., Uchima H; Centro Médico Teknon, Barcelona, Barcelona, Spain., Terán A; Hospital Universitario Marqués de Valdecilla, Santander, Spain., Alberto A; Complejo Universitario de Salamanca, Salamanca, Spain., Joaquín RS; Hospital General Universitario de Ciudad Real, Ciudad Real, Spain., Liseth RS; Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain., José S; Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2021 Jul; Vol. 9 (6), pp. 718-726. Date of Electronic Publication: 2021 Jun 02.
DOI: 10.1002/ueg2.12101
Abstrakt: Introduction: Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use.
Objectives: To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer.
Patients and Methods: The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en-bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed.
Results: Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty-eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60-150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45-121] vs. 110 min [62-160]; p = 0.038). En-bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1-11.74 and OR 5.07, 95%CI 1.6-16.08; respectively).
Conclusions: Although the number of cases is limited, the results of this analysis show acceptable en-bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD.
(© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.)
Databáze: MEDLINE
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