Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients’ perspectives

Libânio, Diogo; Braga, V.; Ferraz, Sílvia de Barros; Castro, Raquel; Lage, Jorge; Pita, Inês; Ribeiro, Cátia; Sousa, Joaquim Abreu de; Dinis-Ribeiro, Mário; Pimentel‐Nunes, Pedro

doi:10.1055/a-0628-6601

Cited by 45 publications

(41 citation statements)

References 22 publications

(10 reference statements)

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“…This was externally validated by the same group, and for a diagnosis of OLGIM III/VI the AUC was 0.96 (95% CI 0.93 to 0.98). This endoscopic grading of GIM was 89% sensitive and 95% specific for a risk stratification of moderate to severe GIM if a cut-off score of >4 was used 172. On this basis, it could be argued that endoscopic staging with high-resolution WLE plus NBI is sufficiently accurate for diagnosis and staging.…”

Section: Summary Of Statements Recommendations and Suggestionsmentioning

confidence: 96%

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

Banks

Graham

Jansen

et al. 2019

Gut

417

388

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Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer—in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met.

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Section: Summary Of Statements Recommendations and Suggestionsmentioning

confidence: 96%

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

Banks

Graham

Jansen

et al. 2019

Gut

417

388

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“…This minimally invasive treatment approach not only offers an excellent prognosis but also substantially improves the quality of life of patients with EGC. 2,3 Despite the above, ESD is a highly demanding technique with a higher risk of perforation than standard EMR methods. 4 It requires a fully skilled endoscopist to ensure success and reduce adverse events; this entails specific training and an appropriate learning curve.…”

Section: Introductionmentioning

confidence: 99%

“…The main advantage of ESD relies in its ability to achieve en‐bloc instead of piecemeal resection regardless of the size of the lesion or presence of fibrosis. This minimally invasive treatment approach not only offers an excellent prognosis but also substantially improves the quality of life of patients with EGC 2,3 …”

Section: Introductionmentioning

confidence: 99%

Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry

et al. 2021

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Introduction: Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives:To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods:The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en-bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed.Results: Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty-eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60-150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45-121] vs. 110 min [62-160]; p = 0.038). En-bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability wereThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Although these programs can also be cost-effective in intermediate risk countries [59,60], they have still not been implemented, and current recommendations suggest the diagnosis and surveillance of individuals with extensive preneoplastic conditions through the use of IEE [59,[61][62][63]. This approach allows the possibility of offering an endoscopic treatment instead of gastric surgery, so avoiding the associated morbidity and mortality [59,62,64,65]. According to the IEE technology being used, descriptors for preneoplastic conditions or EGC have been modified over time.…”

Section: Discussionmentioning

confidence: 99%

Image-enhanced endoscopy for gastric preneoplastic conditions and neoplastic lesions: a systematic review and meta-analysis

et al. 2020

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Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. Methods Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85) and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI 0.97–0.98) on per-biopsy basis. The use of magnification improved the performance of NBI to characterize early gastric cancer (EGC), especially when the vessel plus surface (VS) classification was applied. Regarding other technologies, trimodal imaging also obtained a high accuracy for dysplasia (sensitivity 0.93 [95 %CI 0.85–0.98], specificity 0.98 [95 %CI 0.92–1.00]). For atrophic gastritis, no specific pattern was noted and none of the technologies reached good diagnostic yield. Conclusion NBI is highly accurate for GIM and dysplasia. The presence of tubulovillous pattern and the VS classification seem to be useful to detect GIM and characterize EGC, respectively. These features should be used in current practice and to standardize endoscopic criteria for other technologies.

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Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients’ perspectives

Abstract: In patients with early gastric neoplasia, ESD is safer and is associated with a positive impact on health-related QoL when compared with gastrectomy, without increasing fear of recurrence and new lesions.

Cited by 45 publications

References 22 publications

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry

Image-enhanced endoscopy for gastric preneoplastic conditions and neoplastic lesions: a systematic review and meta-analysis

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