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

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

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.

Original languageEnglish
Pages (from-to)531-536
Number of pages6
JournalDigestive diseases and sciences
Volume60
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

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

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