LONG-TERM CLINICAL OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN GASTRIC EPITHELIAL LESIONS: A SPANISH SINGLE-CENTER COHORT

Aims:

To analyze recurrence rates at 5-year follow-up after gastric ESD in a cohort of patients, according to different variables.

Methods:

Patients with gastric epithelial lesions who underwent ESD were included from a Spanish single referral center. Prospective data (from 2008 to 2015) were collected about patients and lesions characteristics. Kaplan-Meier curves were used to analyze the 5-year-recurrence rate and results were compared according to different factors (bloc vs. piecemeal resection, R0 resections, lateral margins (LM) involvement, histology) using log-rank test.

Results:

49 patients with gastric ESD were initially included. 14 cases were excluded: 2 cases with positive vertical margin (VM+) because need of surgery; 3 cases with no epithelial lesions and 9 cases lost follow-up. Finally, data from 35 patients were analyzed. Most frequent location was lower third (62.9%) and morphology Type 0-IIa+IIc (34.3%). Median size lesion was 26 mm. The main histology was Vienna 4 (48.5%) and Vienna 5 (34.3%). Median follow-up was 33.62 months (range 6 – 60). R0 resection rate was 80% and bloc resection rate was 85.7%. Two cases had LM+ and 5 cases LM unknown (20%). Local recurrence rate at 5-years was 11.4% (4 patients). A second ESD was performed in two of these cases. Recurrence rate was higher in LM+ and piecemeal resection groups, without statistical significance (p = 0,057 and p = 0.48 respectively). Disease-free-survival rate was 88.6%. No patient required surgery and no cancer gastric related death was reported.

Conclusions:

In our study the disease-free-survival rate at 5 years was 88.6%. Lateral margins involvement and piecemeal resection were associated with higher recurrence rate (p = 0.057 and p = 0.48) ESD can achieve high rates of long-term curative treatment in our cohort.