Journal article
Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America
Clinical gastroenterology and hepatology, Vol.19(8), pp.1611-1619.e1
08/01/2021
DOI: 10.1016/j.cgh.2020.06.023
PMID: 32565290
Abstract
Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America.
We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death.
Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD.
ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
Details
- Title: Subtitle
- Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America
- Creators
- Saowanee Ngamruengphong - Johns Hopkins HospitalLorenzo Ferri - Montreal General HospitalHiroyuki Aihara - Brigham and Women's HospitalPeter V. Draganov - University of FloridaDennis J. Yang - University of FloridaYaseen B. Perbtani - University of FloridaTerry L. Jue - Kaiser Permanente San Francisco Medical CenterCraig A. Munroe - Kaiser Permanente San Francisco Medical CenterEshandeep S. Boparai - Kaiser Permanente San Francisco Medical CenterNeal A. Mehta - Cleveland ClinicAmit Bhatt - Cleveland ClinicNikhil A. Kumta - Mount Sinai HospitalMohamed O. Othman - Baylor University Medical CenterMichael Mercado - Baylor University Medical CenterHuma Javaid - Baylor University Medical CenterAbdul Aziz Aadam - Northwestern UniversityAmanda 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 Novikov - Thomas Jefferson University HospitalAlexander Schlachterman - Thomas Jefferson University HospitalThomas Kowalski - Thomas Jefferson University HospitalJason Samarasena - University of California, IrvineRintaro Hashimoto - University of California, IrvineNabil El Hage Chehade - University of California, IrvineJohn Lee - University of California, IrvineKenneth Chang - University of California, IrvineBailey Su - NorthShore University HealthSystemMichael B. Ujiki - NorthShore University HealthSystemAmit Mehta - Cornell UniversityReem Z. Sharaiha - Cornell UniversityDavid L. Carr-Locke - Weill Cornell MedicineAlex Chen - Montreal General HospitalMichael Chen - Montreal General HospitalYen-I. Chen - McGill UniversityMirMilad Pourmousavi Khoshknab - Johns Hopkins HospitalRui Wang - Johns Hopkins HospitalTossapol Kerdsirichairat - Johns Hopkins HospitalYutaka Tomizawa - University of WashingtonDaniel von Renteln - Université de MontréalVivek Kumbhari - Johns Hopkins HospitalMouen A. Khashab - Johns Hopkins HospitalRobert Bechara - Queen's UniversityMichael Karasik - Hartford HospitalNeej J. Patel - Mayo Clinic in FloridaNorio Fukami - Mayo Clinic in FloridaMakoto Nishimura - Memorial Sloan Kettering Cancer CenterYuri Hanada - Mayo ClinicLouis M. Wong Kee Song - Mayo ClinicMonika Laszkowska - Columbia University Irving Medical CenterAndrew Y. Wang - University of VirginiaJoo Ha Hwang - Stanford UniversityShai Friedland - Hartford HospitalAmrita Sethi - Columbia University Irving Medical CenterAntony N. Kalloo - Johns Hopkins Hospital
- Resource Type
- Journal article
- Publication Details
- Clinical gastroenterology and hepatology, Vol.19(8), pp.1611-1619.e1
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.cgh.2020.06.023
- PMID
- 32565290
- ISSN
- 1542-3565
- eISSN
- 1542-7714
- Language
- English
- Date published
- 08/01/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984695684402771
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