Surgical Endoscopy

, Volume 27, Issue 3, pp 1000-1008

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes

  • Takashi ToyonagaAffiliated withDepartment of Endoscopy, Kobe University Hospital Email author 
  • , Mariko Man-iAffiliated withFrontier Medical Science in Gastroenterology, Kobe University School of Medicine
  • , James E. EastAffiliated withTranslational Gastroenterology Unit, John Radcliffe Hospital
  • , Eisei NishinoAffiliated withPathology, Kishiwada Tokushukai Hospital
  • , Wataru OnoAffiliated withGastroenterology, Kishiwada Tokushukai Hospital
  • , Tomoomi HirookaAffiliated withGastroenterology, Fuchu Hospital
  • , Chie UedaAffiliated withGastroenterology, Kishiwada Tokushukai Hospital
  • , Yoshinori IwataAffiliated withGastroenterology and Hepatology, Hyogo College of Medicine
  • , Takeshi SugiyamaAffiliated withGastroenterology, Sakibana Hospital
    • , Toshio DozaikuAffiliated withGastroenterology, Fuchu Hospital
    • , Takashi HirookaAffiliated withGastroenterology, Fuchu Hospital
    • , Tsuyoshi FujitaAffiliated withFrontier Medical Science in Gastroenterology, Kobe University School of Medicine
    • , Hideto InokuchiAffiliated withGastroenterology, Hyogo Cancer Center
    • , Takeshi AzumaAffiliated withFrontier Medical Science in Gastroenterology, Kobe University School of Medicine



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.


Endoscopic submucosal dissection Complication Postoperative Prognosis Neoplasms