Abstract
646 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC NEOPLASIA: A LARGE MULTICENTER STUDY FROM NORTH AMERICA
Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB102-AB103
06/2019
DOI: 10.1016/j.gie.2019.04.100
Abstract
Background
In Western countries, most patients with early gastric cancer (EGC) are still being treated with gastrectomy. Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for EGC in Asia and has become increasingly performed in the West. To date, outcomes data on gastric ESD in the Western settings have been limited to small, single-center studies, with a lack of data coming from North America.
Aims
To evaluate gastric ESD outcomes across various centers in North America.
Methods
This was a retrospective analysis of prospectively collected data on consecutive patients with gastric epithelial neoplasia who underwent ESD between 1/2008 to 10/2018 at 19 centers. Primary end point was the rate of en bloc resection. Secondary outcomes included: (1) rate of complete (R0) and curative resection, (2) adverse event rates, and (3) rates of recurrence and gastric cancer-related death.
Results
Of 253 patients who were referred for gastric ESD, ESD was not technically feasible in 6 cases (1 due to deeply invasive cancer and 5 due to severe submucosal fibrosis from prior endoscopic resection). In 247 patients (mean age 69 yrs; 56% male; 50% Caucasian), including 143 (58%) adenomas, 67 (27%) EGC, and 28 (11%) neuroendocrine tumors (NET), ESD was attempted. Median procedure time was 90 min (IQR 55 – 124). In 38% of cases, ESD was performed in an outpatient setting. En-bloc resection rates for all lesions, EGCs, adenomas, and NETs were 92%, 94%, 89%, and 90%, respectively. R0 resection rates for all lesions, EGC, adenomas, and NET were 81%, 76%, 87%, and 70%, respectively. Curative resection according to Japanese criteria was achieved in 76% (16/21) of EGCs fulfilling the standard criteria and 69% (25/36) of EGCs fulfilling the expanded criteria. Intraprocedural perforation occurred in 8%(n=21). Of these, all but two cases were treated successfully with endoscopic therapy. Two cases (0.8%) required surgery due to perforation, and both occurred during the early phase of the learning curve. Delayed bleeding occurred in 8 cases (3%). No delayed perforation or procedure-related deaths were observed. In the EGC cohort, local recurrence was observed in 4 cases (11%) and all were following non-curative resection. In the gastric adenoma group, there were 5 (6.7%) local recurrences after ESD (1.8% after R0 resection vs 44% after non-R0 resection, p=0.001). After a median follow-up of about 12 months post-operatively, no metastatic recurrences or gastric cancer-related deaths were observed.
Conclusion
This large multicenter study demonstrated high rates of en bloc and R0 resections of gastric neoplasia in North America, comparable to that of Eastern centers. We recommend ESD as treatment of choice for gastric neoplasia including lesions fulfilling standard and expanded criteria for EGC.
Details
- Title: Subtitle
- 646 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC NEOPLASIA: A LARGE MULTICENTER STUDY FROM NORTH AMERICA
- Creators
- Saowanee Ngamruengphong - Johns Hopkins MedicineRintaro Hashimoto - University of California, IrvineLorenzo E. Ferri - Montreal General HospitalHiroyuki Aihara - Brigham and Women's HospitalPeter V. Draganov - University of FloridaDennis Yang - University of FloridaYaseen B. Perbtani - University of FloridaYuri Hanada - Mayo Clinic in ArizonaLouis M. Wong Kee Song - Mayo ClinicNikhil A. Kumta - Icahn School of Medicine at Mount SinaiMohamed O. Othman - Baylor College of MedicineMichael O. Mercado - Baylor College of MedicineHuma Javaid - Baylor College of MedicineA. Aziz Aadam - Northwestern UniversityAmanda B. Siegel - Northwestern UniversityTheodore W. James - University of North Carolina at Chapel HillIan S. Grimm - University of North Carolina at Chapel HillJohn M. DeWitt - Indiana University – Purdue University IndianapolisAleksey A. Novikov - Thomas Jefferson UniversityAlexander Schlachterman - Thomas Jefferson UniversityThomas E. Kowalski - Thomas Jefferson UniversityJason B. Samarasena - University of California, IrvineNabil E. Chehade - University of California, IrvineJohn Lee - University of California, IrvineKenneth J. Chang - University of California, IrvineBailey Su - University of ChicagoAlex Chen - Montreal General HospitalMichael Chen - Montreal General HospitalYen-I Chen - McGill UniversityMichael Ujiki - NorthShore University HealthSystemAmit Mehta - Cornell UniversityReem Z. Sharaiha - Cornell UniversityDavid L. Carr-Locke - Weill Cornell MedicineVivek Kumbhari - Johns Hopkins MedicineMouen A. Khashab - Johns Hopkins MedicineMirMilad Pourmousavi Khoshknab - Johns Hopkins MedicineRui Wang - Johns Hopkins MedicineTossapol Kerdsirichairat - Johns Hopkins MedicineYutaka Tomizawa - University of WashingtonDaniel von Renteln - Université de MontréalRobert Bechara - Queen's UniversityNeej J. Patel - Mayo Clinic in ArizonaNorio Fukami - Mayo Clinic in ArizonaMonika Lazkowska - Columbia University Irving Medical CenterAmrita Sethi - Columbia University Irving Medical CenterAndrew Y. Wang - University of VirginiaJoo Ha Hwang - Stanford UniversityShai Friedland - Stanford UniversityAnthony N. Kalloo - Johns Hopkins Medicine
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB102-AB103
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.gie.2019.04.100
- ISSN
- 0016-5107
- eISSN
- 1097-6779
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984697053802771
Metrics
1 Record Views