Clin Endosc.  2022 Mar;55(2):248-255. 10.5946/ce.2021.192.

Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study

• Palacios-Salas F
• Benites-Goñi H
• Marin-Calderón L
• Bardalez-Cruz P
• Vásquez-Quiroga J
• Alva-Alva E
• Medina-Morales B
• Asencios-Cusihuallpa J

• KMID: 2527569
• DOI: http://doi.org/10.5946/ce.2021.192

Abstract

Background/Aims
Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC.
Methods
We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure.
Results
The mean patient age was 68.4 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively.
Conclusions
Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

Keyword

Adverse effects; Endoscopic submucosal dissection; Gastric cancer; Treatment outcome

Figure

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  Fig. 1. Endoscopic submucosal dissection of an early gastric cancer (0-IIb+IIa) on the gastric body. (A) Marking outside the lesion. (B) Peripheral partial incision. (C) Submucosal dissection. (D) Post-resection ulcer. (E) Fixation of the tissue specimen. (F) Low-power view of the resected specimen shows differentiated adenocarcinoma (hematoxylin & eosin stain, ×40).

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  Fig. 2. Endoscopic submucosal dissection of a synchronous early gastric cancer. (A, B) An early gastric cancer (0-IIa) on the gastric angle. (C) Peripheral incision. (D) Submucosal dissection. (E) Post-resection ulcer. (F) Fixation of the tissue specimen. (G) Specimen sections. (H) Low-power view of the resected specimen shows differentiated adenocarcinoma (hematoxylin & eosin stain, ×20).

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  Fig. 3. Indications for endoscopic submucosal dissection, main outcomes and curability criteria. LGD, low-grade dysplasia.

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