How Is Endoscopic Submucosal Dissection for Gastrointestinal Lesions Being Implemented?: Results from an International Survey

• Main Author: Araújo-Martins,Miguel
• Publication Date: 2020
• Other Authors: Pimentel-Nunes,Pedro, Libânio,Diogo, Borges-Canha,Marta, Dinis-Ribeiro,Mário
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452020000100001
• topic: Endoscopic submucosal dissection; Survey; Gastrointestinal superficial lesions

Background and Study Aim: Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resec-tion (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; how-ever, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. Methods: Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from Decem-ber 2017 to February 2018. Results: A total of 58 endosco-pists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the co­ lorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complica-tions (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected le-sions were intramucosal adenocarcinoma (59% in the esoph-agus; 47% in the stomach), while in the colorectum the ma-jority were adenomas (59%). Conclusion: ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully imple-mented in Western countries, achieving a good rate of effi-cacy and safety according to European guidelines.