Long-Term Outcomes of Non-Curative Endoscopic Submucosal Dissection Resection of Gastric Lesions

Aims Recent studies questioned the benefit of additional surgery in all patients submitted to a non-curative endoscopic submucosal dissection (ESD) for early malignant lesions. This study aims to evaluate the outcomes of patients selected for gastric ESD in a tertiary center.

Methods Data were collected from all patients referred to ESD for resection of dysplastic or early malignant gastric lesions in a tertiary center, from May 2012 to August 2020. All procedures were performed by the same endoscopist and the expanded criteria were used to define endoscopic cure. Demographic data, characteristics of the lesion and of the procedure, complications, histological results, and recurrence were recorded. Follow-up was performed with endoscopy at 3-6 months after the ESD and then annually.

Results Two hundred and eighty eight ESDs were performed in 260 patients over 98 months. One hundred fifty-eight patients were male, with an average age of 68.79±9.89, and 188 patients (65.28 %) presented significant comorbidities. The most significant ESD complications were post-procedure bleeding (n = 18; 6.25 %), and intra-procedure perforation (n = 2; 0.69 %), with successful endoscopic treatment in all patients. The proportion of R0 resection was 87.50 %. Forty-six (15.97 %) ESD were considered non-curative, from which 24 were referred for surgical resection. Ten of the 24 patients did not undergo surgery due to patients’ whishes or frailty. Of the 14 patients that underwent surgery, only 4 (28.57 %) had residual dysplastic tissue in the surgical specimens. Four patients had major complications from surgery, with one death. Regarding the 28 patients that maintained endoscopic surveillance, the average follow-up time was 30.65±21.76 months. Recurrence was found in 8 patients (28.57 %) with dysplastic lesions managed endoscopically in all cases.

Conclusions In this cohort, it was observed a benign course during long-term follow-up of patients after non-curative ESDs. Further studies may allow a better selection of patients who benefit from additional surgical treatment.

Citation: Silva Mendes S, Ferreira A, Costa R et al. eP4 LONG-TERM OUTCOMES OF NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION RESECTION OF GASTRIC LESIONS. Endoscopy 2021; 53: S98.

Publication History

Article published online:
19 March 2021