Endoscopy 2014; 46(11): 933-940
DOI: 10.1055/s-0034-1377348
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal

Pedro Pimentel-Nunes
1  Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3  CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Francisco Mourão
3  CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Nuno Veloso
1  Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3  CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Luís Pedro Afonso
4  Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
,
Manuel Jácome
4  Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
,
Luís Moreira-Dias
1  Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
,
Mário Dinis-Ribeiro
1  Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3  CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
› Author Affiliations
Further Information

Publication History

submitted 26 November 2013

accepted after revision 15 May 2014

Publication Date:
14 July 2014 (eFirst)

Background and study aims: Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal.

Patients and methods: This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n = 54) or ESD (n = 141) and were followed up for a median of 3.2 years.

Results: Resection was feasible in 97 %, with en bloc and R0 resection rates of 85 % (94 % ESD vs. 61 % EMR; P = 0.001) and 81 % (91 % ESD vs. 54 % EMR; P < 0.001), respectively. The recurrence rate was 7 %, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95 % confidence interval 3.9 – 8.8). The long-term curative resection rate was 86 % after one procedure and 91 % after two procedures. Adverse events were observed in 13 % of cases: 8 % bleeding and 2 % of perforations (EMR = ESD). Surgery was performed in 7 %: 6 % after noncurative endoscopic resection and 1 % due to complications. Metachronous lesion detection rate was 1 % – 1.5 % per patient year. Cancer-specific survival rate was 100 % at follow-up.

Conclusions: For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries.