Long term outcomes of endoscopic submucosal dissection for early oesophageal squamous neoplasia across four European tertiary centres

Aims Endoscopic submucosal dissection (ESD) is established as a curative treatment for early esophageal squamous cell carcinoma (ESCC). ESCC is uncommon in Europe and north America explaining limited published data on western cohorts. This study aimed to analyse the technical outcomes and long term outcomes from a large western international multicentre cohort.

Methods Multicentre retrospective cohort study to evaluate the outcomes of ESD for ESCC from four tertiary centres across Europe. Data from consecutive patients were collected between 2013 to 2024. All ESD procedures were performed by experienced endoscopists. Outcomes were en bloc resection rate, R0 resection rate, technical success rate, curative resection rate, stricture rate and overall survival.

Results 103 ESDs were carried out for ESCC on 95 patients over a 13 year period (October 2011-October 2024) Median follow up 36 months (95% CI 24-47 months). Median age 69 (range 33-85, 53 males, 44 females). Histological analysis of these lesions showed: 27 had T1a, 36 had T1b, 36 had HGD, four had LGD. En bloc resection rate 97.1% (95% CI 94%-100%). R0 resection rate for cancer was 85.7% (95% CI 79%-92%). 19% of resection specimens showed dysplasia involved at the margin. Overall, the technical success rate 99% (95% CI 95%-99%), one ESD was abandoned due to deep tumour invasion. Curative resection rate 23.8% (95% CI 14%-33%) as 71% of the cancers had invasion deeper than M2. 76 patients had endoscopic surveillance. 21 patients had only one follow up endoscopy before being lost to follow up, dying or having chemo-radiotherapy or surgery. 12.6% of patients had metachronous lesions and were all managed with further ESD. 7% (7/95) of patients had local recurrence, of whom four had further ESD, two were palliated due to co-morbidities and one patient had surgery. Three patients developed lymph node metastases between 8-18 months post ESD. Overall, six patients went on to have surgery, four patients went on to have chemoradiotherapy. Stricture rate was 24% (95% CI 16%-33%) and was strongly correlated with percentage of oesophageal circumference resected (r=0.67, p<0.01). Overall, 5-year survival was 89% (95% CI 80%-96%). Two out of 95 patients died following ESCC progression providing a 5-year ESCC- specific survival of 95.3% (95% CI 91%-99%). Both patients had lympho-vascular invasion on histology followed by recurrence one deemed not fit for surgery, the other patient developed lymph node metastases and had chemo-radiotherapy then died.

Conclusions In this large European cohort with long term follow up we demonstrate the effectiveness and safety of ESD for ESCC. A high R0 and technical success rate was achieved but curative resection rates were low due to advanced disease at diagnosis. The long-term survival is in keeping with other western cohorts and is impacted by a significantly co-morbid patient population.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025