Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

Abstract

Background and Aims. Endoscopic submucosal dissection (ESD) outcomes have traditionally been reported from high volume centers in East Asia. Data from low volume centers in other parts of Asia remain sparse. Methods. A retrospective survey with a structured questionnaire of 5 tertiary centers in 3 countries in South East Asia was conducted. Details of training and clinical outcomes of ESD cases, with follow-up data from these centers, were analyzed. Results. Seven endoscopists from the 5 centers performed a total of 35 cases of ESD in the upper gastrointestinal tract (UGIT) over a 6-year duration. Details of the lesions excised were as follows: median size was 20 mm, morphologically 20 (68.6%) were flat/depressed and 6 (17.1%) were submucosal, and histologically 27 (77.1%) were neoplastic. The median duration of ESD procedures was 105 minutes, with an en-bloc resection rate of 91.4%. There was 1 (2.9%) case of delayed bleeding, but no perforation nor mortality in any of the cases. The recurrence rate after ESD was 5.7%. A prolonged ESD duration was influenced by a larger size of lesion (25 mm, p = 0.02) but not by factors related to the training experience of endoscopists. Conclusions. ESD in the UGIT is feasible and safe in low volume centers in Asia.

Acquiring new complex endoscopic skills: Experience from the development of peroral endoscopic myotomy (POEM) in Malaysia

“…As mentioned earlier, our center had been performing ESD for several years prior to initiating our POEM service. The results of our ESD experience had been reported previously, 16 indicating a comparable outcome with large volume centers globally.…”

“…The incidence of gastric cancer is low in Malaysia and Southeast Asia 18 . Hence, the uptake and interest in ESD has been limited, apart from a few specialized centers 16 . In contrast, achalasia is not that uncommon 1 and hence relying solely on prior experience in ESD in this region will reduce the uptake of POEM in this region too.…”

Non-cardia early gastric cancer in Central Vietnam: noticeable uncommon background mucosa and results of endoscopic submucosal dissection

“…The technical indicators such as ESD time and en bloc resection rate were comparable with other studies. The details are presented in Table 3 and the comparison with other studies, which were conducted in areas with similar ESD development, is demonstrated in Table 4 22 23 24 .…”

Towards achieving mastery in advanced endoscopic procedures: Standardized training programs and improved endoscopic systems

“…As a result, unlike in Japan where young endoscopists can embark on ESD after adequate training, endoscopists in Southeast Asia accumulate significant amounts of endoscopic experience and perform endoscopic mucosal resections (EMR) prior to embarking on ESD. In the study conducted by Azmi et al, 7 all endoscopists had performed EMR previously before embarking on ESD, all endoscopists had completed animal model training for ESD, and three endoscopists underwent further training in Japan.…”