1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes
Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasms; however, most ESD articles report small series, with short-term outcomes performed by multiple operators on single organ. We assessed short- and long-term treatment outcomes following ESD for early neoplasms throughout the gastrointestinal tract.
We performed a longitudinal cohort study in single tertiary care referral center. A total of 1,635 early gastrointestinal neoplasms (stomach 1,136; esophagus 138; colorectum 361) were treated by ESD by single operator. Outcomes were complication rates, en bloc R0 resection rates, and long-term overall and disease-specific survival rates at 3 and 5 years for both guideline and expanded criteria for ESD.
En bloc R0 resection rates were: stomach: 97.1 %; esophagus: 95.7 %; colorectum: 98.3 %. Postoperative bleeding and perforation rates respectively were: stomach: 3.6 and 1.8 %; esophagus: 0 and 0 %; colorectum: 1.7 and 1.9 %. Intra criteria resection rates were: stomach: 84.9 %; esophagus: 81.2 %; colorectum: 88.6 %. Three-year survival rates for lesions meeting Japanese ESD guideline/expanded criteria were for all organ-combined: 93.4/92.7 %. Five-year rates were: stomach: 88.1/84.6 %; esophagus: 81.6/57.3 %; colorectum: 94.3/100 %. Median follow-up period was 53.4 (range, 0.07–98.6) months. Follow-up rate was 94 % (1,020/1,085). There was no recurrence or disease-related death.
In this large series by single operator, ESD was associated with high curative resection rates and low complication rates across the gastrointestinal tract. Disease-specific and overall long-term prognosis for patients with lesions within intra criteria after curative resection appeared to be excellent.
- 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes
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Volume 27, Issue 3 , pp 1000-1008
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- 1. Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
- 2. Frontier Medical Science in Gastroenterology, Kobe University School of Medicine, Kobe, Hyogo, Japan
- 3. Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
- 4. Pathology, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
- 5. Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
- 6. Gastroenterology, Fuchu Hospital, Izumi, Osaka, Japan
- 7. Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- 8. Gastroenterology, Sakibana Hospital, Izumi, Osaka, Japan
- 9. Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan