Background & Aims

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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内窥镜黏膜下剥离术治疗北美一大群浅表性胃肿瘤的疗效

背景与目标

内窥镜黏膜下剥离术 (ESD) 是亚洲浅表性胃肿瘤的一种广泛接受的治疗选择，但北美关于胃 ESD 结局的数据很少。我们旨在评估北美胃 ESD 的安全性和有效性。

方法

我们分析了 2010 年至 2019 年在 25 个中心接受胃 ESD 的 347 名患者的数据。我们收集了有关患者人口统计学、病变特征、手术细节和相关不良事件、治疗结果、局部复发和最后一次随访时的生命状态的数据. 对于具有可用随访数据的 277 名患者，初始 ESD 与最后一次临床或内窥镜评估之间的中位间隔为 364 天。主要终点是整块和 R0 切除率。次要结局包括根治性切除、不良事件和复发率以及胃癌相关死亡。

结果

90 名患者 (26%) 患有低级别腺瘤或不典型增生，82 名患者 (24%) 患有高度不典型增生，139 名患者 (40%) 患有早期胃癌，36 名患者 (10%) 患有神经内分泌肿瘤。所有病灶整块和R0切除比例为92%/82%，早期胃癌为94%/75%，腺瘤和低度不典型增生为93%/92%，高度不典型增生为89% / 87%，而对于神经内分泌肿瘤则为 92%/75%。6.6% 的患者发生术中穿孔；其中 82% 的患者通过内窥镜治疗成功治疗。2.6% 的患者发生延迟出血。没有观察到延迟穿孔或手术相关的死亡。3.9%的病例局部复发；均发生在非治愈性 ESD 切除术后。在 14 名患者 (6.9%) 中发现了异时性病变。

结论

ESD 是治疗浅表性胃瘤的一种非常有效的方法，应被视为北美患者的可行选择。局部复发的风险很低，并且只发生在非治愈性切除后。需要仔细的内窥镜监测来识别和治疗异时性病变。