Digestive Diseases and Sciences

, Volume 60, Issue 2, pp 531–536 | Cite as

A Single-Center Experience of Endoscopic Submucosal Dissection Performed in a Western Setting

  • Gabriel D. Lang
  • Vani J. A. Konda
  • Uzma D. Siddiqui
  • Ann Koons
  • Irving Waxman
Original Article

Abstract

Background

Compared with the piecemeal resection associated with endoscopic mucosal resection, endoscopic submucosal dissection (ESD) enables en bloc resection of larger lesions, allows for more accurate histological assessments, and has reduced recurrence rates. ESD is not widely performed in Western countries given increased technical difficulty, high complication rates, and long procedure times.

Aims

To evaluate the safety and efficacy of ESD in a single center in the USA.

Methods

A retrospective study on a prospectively collected database identified cases in which a single operator (IW) performed ESD at a tertiary referral center. Twenty cases were identified, nine in the upper digestive tract (four esophagus and five stomach) and 11 in the lower digestive tract (nine rectal and two sigmoid colon). Data regarding lesion location, pathology, method of ESD (composition/volume of lifting injection and resection method), post-procedure complications, and margin involvement were collected.

Results

En bloc resection was obtained in 14/20 patients (70 %). The average procedure time was 202 min in the esophagus, 148 min in the stomach, and 106 min for lower lesions. A major complication (perforation) occurred in 1/20 cases (5 %). Complete resection was obtained in 14/20 (70 %). R0 resection was obtained in 16/20 (80 %) cases.

Conclusions

The complication, en bloc resection, and complete resection rates of this study are similar to those found in large studies on ESD performed in Eastern settings. ESD is safe and efficacious for en bloc resections of pre-malignant and early-invasive lesions, and should be offered to patients with suitable lesions in Western settings.

Keywords

Endoscopic submucosal dissection (ESD) Endoscopic mucosal resection (EMR) Dysplasia-associated lesion or mass (DALM) Endoscopy 

References

  1. 1.
    Gotoda T, Kondo H, Ono H, et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc. 1999;50:560–563.PubMedCrossRefGoogle Scholar
  2. 2.
    Ohkuwa M, Hosokawa K, Boku N, et al. New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy. 2001;33:221–226.PubMedCrossRefGoogle Scholar
  3. 3.
    Probst A, Golger D, Arnholdt H, et al. Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in gastrointestinal tract. Clin Gastroenterol Hepatol. 2009;7:149–155.PubMedCrossRefGoogle Scholar
  4. 4.
    Cao Y, Liao C, Tan A, et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy. 2009;9:751–757.CrossRefGoogle Scholar
  5. 5.
    Yamamoto H. Endoscopic submucosal dissection—current success and future directions. Nat Rev Gastroenterol Hepatol. 2012;9:519–529.PubMedCrossRefGoogle Scholar
  6. 6.
    Chandrasekhara V, Ginsberg GG. ESD for colorectal neoplasms: dissecting value from virtue. Gastrointest Endosc. 2011;5:1084–1086.CrossRefGoogle Scholar
  7. 7.
    Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;7:1909–1918.CrossRefGoogle Scholar
  8. 8.
    Smith LA, Baraza W, Tiffin N, et al. Endoscopic resection of adenoma-like mass in chronic ulcerative colitis using a combined endoscopic mucosal resection and cap assisted submucosal dissection technique. Inflamm Bowel Dis. 2008;14:1380–1386.PubMedCrossRefGoogle Scholar
  9. 9.
    Odze R, Farraye F, Hecht J, et al. Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis. Clin Gastroenterol Hepatol. 2004;7:534–541.CrossRefGoogle Scholar
  10. 10.
    Ullman T, Odze R, Farraye F, et al. Diagnosis and management of dysplasia in patients with ulcerative colitis and crohn’s disease of colon. Inflamm Bowel Dis. 2009;15:630–638.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;6:1217–1225.CrossRefGoogle Scholar
  12. 12.
    Draganov PV, Gotoda T, Chavalitdhamrong D, et al. Techniques of endoscopic submucosal dissection: application for the western endoscopist? Gastrointest Endosc. 2013;5:677–678.CrossRefGoogle Scholar
  13. 13.
    Colin A, Kaltenback T, Kusano C, et al. Endoscopic resection of gastrointestinal lesions: advancement in the application of endoscopic submuosal dissection. J Gastroenterol Hepatol. 2010;25:1348–1357.CrossRefGoogle Scholar
  14. 14.
    Doty JR, Salazar JD, Forastiere AA, et al. Postesophagectomy morbidity, mortality, and length of hospital stay after preoperative chemoradiation. Ann Thorac Surg. 2002;74:227–231.PubMedCrossRefGoogle Scholar
  15. 15.
    Dhamija A, Hancock J, McCloskey B, et al. Minimally invasive oesophagectomy more expensive than open despite shorter length of stay. Eur J Cardiothorac Surg. 2014;45:904–909.PubMedCrossRefGoogle Scholar
  16. 16.
    Schoetz DJ, Bockler M, Rosenblatt MS, et al. Ideal length of stay after colectomy: whose ideal? Dis Colon Rectum. 1997;40:806–810.PubMedCrossRefGoogle Scholar
  17. 17.
    Salimath J, Jones MW, Hunt DL, et al. Comparison of return of bowel function and length of stay in patients undergoing laparoscopic versus open colectomy. JSLS. 2007;11:72–75.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Cardoso DM, Campoli PM, Yokoi C, et al. Initial experience in Brazil with endoscopic submucosal dissection for early gastric cancer using insulation-tipped knife: a safety and feasibility study. Gastric Cancer. 2008;4:226–232.CrossRefGoogle Scholar
  19. 19.
    Scumacher B, Charton J, Nordmann T, et al. Endoscopic submucosal dissection of early gastric neoplasia with a water-jet assisted knife: a western, single center experience. Gastrointest Endosc. 2012;75:1166–1174.CrossRefGoogle Scholar
  20. 20.
    Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M, et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc. 2009;2:350–355.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gabriel D. Lang
    • 1
    • 2
  • Vani J. A. Konda
    • 1
    • 2
  • Uzma D. Siddiqui
    • 1
    • 2
  • Ann Koons
    • 1
    • 2
  • Irving Waxman
    • 1
    • 2
  1. 1.Department of Medicine, Center for Endoscopic Research and Therapeutics (CERT)The University of Chicago MedicineChicagoUSA
  2. 2.Center for Care and DiscoveryThe University of Chicago MedicineChicagoUSA

Personalised recommendations