MUCOSAL ENDOSCOPIC RESECTION OF LARGE LESIONS OF THE UPPER DIGESTIVE TRACT

Aims:

Endoscopic mucosal resection (EMR) of upper digestive tract (UDT) lesions presents a good success rate and an excellent safety profile.

The aim is to investigate the efficacy and safety of EMR of significant lesions of UDT in our center.

Methods:

Observational, unicenter, retrospective study of a cohort of patients with large UDT lesions (> 15 mm) treated by EMR in the last 7 years. Demographic, endoscopic and histological variables were collected. The endpoints were the resection rate R0 (free margins) and complications.

Results:

During the study period, 89 of a total of 172 EMR were performed in lesions greater than 15 mm. Sixty-one percent of patients had associated comorbidities, being diabetes mellitus (11%) and cardiovascular disease (6%) the commonest. Antiplatelet and anticoagulant treatment was present in 26% and 16% (n = 23 and 14) of our patients. Lesions were larger than 20 mm in 57 (64%) of patients. Lesions were located in the stomach in 70 patients (79%), in the esophagus in 14 (15%) and in duodenum in 5 (6%) patients. The most common EMR used technique included diathermy snare with prior submucosal injection (56, 63%). R0 rate was achieved in 65 (73%) patients. Complications occurred in 12 (13%) patients: bleeding in 9 (10%) patients, 1 postpolypectomy syndrome and 2 perforations. Endoscopic follow-up was performed in 17 patients with high risk lesions (19%). There were 6 recurrences. 4 of them were rescued endoscopically, and two required surgical treatment.

Conclusions:

EMR is a safe and efficacious technique to treat large lesions in the UDT. These results are similar to those described in the literature.