Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer - initial experience of a western center

Abstract

BACKGROUNDEndoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection.OBJECTIVETo evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University.MATERIALS AND METHODSTwenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications.RESULTSSixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6–3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20–160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6–30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20–150 min)CONCLUSIONThe endoscopic submucosal dissection technique was feasible in our service with a high success rate.

Endoscopic submucosal dissection of early gastric neoplasia with a water jet–assisted knife: a Western, single-center experience

“…2,25,26 A variety of prospective and retrospective trials from Japan showed that ESD achieves higher rates of curative resection of early gastric cancer than EMR. [23][24][25][27][28][29] The guidelines for ESD are constantly being updated and newly discussed. The acceptable indications for ESD of early gastric cancer are based on the guidelines of the Japanese Gastric Cancer Association.…”

Avanços na abordagem do carcinoma precoce de esôfago

“…There were four cases of perforation treated conservatively. Ishihara et al 34 published a comparative analysis of the ESD in relation to mucosal resection in patients with esophageal cancer of less than 20mm. The rates of en bloc and curative resections of ESD (100% and 97%) were superior to the techniques of endoscopic mucosal resection with cap (87% and 71%) and by strip biopsy (71% and 46%).…”

INITIAL EXPERIENCE OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN BRAZIL TO TREAT EARLY GASTRIC AND ESOPHAGHEAL CANCER: a multi-institutional analysis

“…The opportunity of exchanges with centers in Japan, were of the great importance to introducing ESD to Brazil (1) . ESD procedure duration and incidence of complication are directly related to the experience of the endoscopist.…”

“…For esophageal lesions, the indication and cure criteria were: endoscopic signs of early lesion or ecoendoscopic examination confirming tumor limited to the mucosa or up to the superficial submucosa (Sm1); histological confirmation of squamous cell carcinoma or high grade intraepithelial neoplasia restricted to the mucosa (M1 and M2); M3 lesions or those with Sm1 invasion without lymphatic and vascular involvement, superficial size less than 25 mm; no signs of lymph node metastases (1) .…”