Endoscopy 2019; 51(04): S78
DOI: 10.1055/s-0039-1681400
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ESD esophagus Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

CLINICAL OUTCOME OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY ESOPHAGEAL NEOPLASMS IN THE WEST: CAN WE REPRODUCE JAPANESE RESULTS?

R Gardone
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
,
M Salgado Pedrosa
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
,
V Arantes
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic submucosal dissection (ESD) is considered more challenging in the esophagus due thin wall and narrow lumen. The aim of this study is to present the clinical outcome of a ten-year experience with esophageal ESD in a Western center.

Methods:

Single-center retrospective review of prospectively collected data investigating consecutive patients that underwent esophageal ESD between 2009 and 2018, at an Academic Institution. A trained operator performed ESD procedures. Flush Knife BT 1.5 (Fujifilm Co., Japan) was utilized for submucosal dissection. The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rates, and clinical outcome.

Results:

70 esophageal ESD procedures were performed in 66 patients (Male: 79%/mean age 63.5 years). Tumors were located mainly in the thoracic esophagus (64%) and classified as macroscopic type 0-IIb (54%). En-bloc resection rate and R0 resection rate were 97% and 88.5% respectively. Mean tumor size was 44 mm (range 15 to 120 mm). Mean ESD duration was 101 minutes (range: 40 – 230 minutes). Histological assessment revealed low-grade or high-grade dysplasia (M1) in 34 patients (48.5%), intramucosal carcinoma (M2) in 9 patients (13%) and M3 in 15 (21.4%) patients. Superficial (SM1) invasion was noted in 4 patients (5.7%) and deep invasion (SM2) in 8 patients (11.4%). Curative resection rate was 80%. Minor adverse events occurred in 7 cases (10%), all managed conservatively. In 12 patients circumferential resection over 75% of circumference was performed and oral corticoid protocol was instituted. Two patients (2.8%) developed stricture managed with dilation. During follow-up (mean: 35 months, range: 23 – 105), one patient, with positive vertical margins, developed local recurrence. No metastases were observed. Overall survival rate was 82%.

Conclusions:

Esophageal ESD is feasible and effective in the West, yielding favorable short and long-term outcomes, comparable to Japanese series.