Gastric ESD: Preliminary Experience in a Tertiary Center in Quebec

Aims Endoscopic submucosal dissection (ESD) is a common treatment for early gastric cancer (EGC). Western countries have less experience with this challenging technique. The goal of this study is to evaluate the effectiveness of ESD as a preliminary experience.

Methods This is an unicentric retrospective study of all consecutive gastric ESD for adenomas or EGC from 07/2017 to 08/2020. The primary endpoints were en bloc and R0 resection rates.

Results Nineteen patients (mean age 74.2 (54-88)) and 23 lesions were included. Mean diameter was 25 mm (10-90). Treatment was previously performed in 7 cases (30.4 %), by ESD (5) or EMR (2). The procedure, performed under general anaesthesia, lasted on average 148 minutes (45-412). En bloc resections were performed in 16 cases (69.6 %); 5 cases (21.7 %) were converted to P-EMR. Failed resection because of deep invasion or perforation occured in 2 cases (8.7 %). Pathologic examination demonstrated 6 adenomas and 15 adenocarcinomas: intramucosal (8) and submucosal (7). R0 and curative resection rates were 43.5 % and 39.1 % respectively. The procedure related complication rate was 30.4 % consisting of 5 perforations and 2 delayed bleeding: all were managed endoscopically. Five patients (21.7 %) underwent gastrectomy for non-curative resection (4) or failed resection (1), however, 3 had no residual disease on final pathology. One patient went to palliative care because he was unfit for surgery. Follow-up endoscopy was completed in all 17 patients who underwent endoscopic resection (mean 10 months (2-24)). Recurrence occurred in 23.5 % (4/17); all were successfully treated by another ESD.

Conclusions In our preliminary experience, the rate of en bloc and R0 resection were 70 % and 44 %. Compared to other studies, these low en bloc and curative resection rates may be explained by technically difficult lesions during the learning curve and might improve with experience. Nevertheless, surgery has been avoided in 13/19 patients (68 %) with endoscopic intervention.

Citation: Maillet D, Désilets E, Manière T. eP84 GASTRIC ESD: PRELIMINARY EXPERIENCE IN A TERTIARY CENTER IN QUEBEC. Endoscopy 2021; 53: S124.

Publication History

Article published online:
19 March 2021