Endoscopic submucosal dissection for gastric lesions: results of an European inquiry

In Japanese centers, endoscopic submucosal dissection (ESD) is commonly used for the resection of early gastric lesions. However, in Europe, only a few reports have been published. The aim of the current study was to survey the current use of ESD by European endoscopists.

Between April and May 2009, European endoscopists (n = 490) who had articles published in the journals Endoscopy and/or Gastrointestinal Endoscopy during 2007 and 2008 were asked to complete an online questionnaire.

A total of 58 endoscopists completed the questionnaire (12 %). Only 20 centers performed ESD, which was mostly performed by a single endoscopist in each center. Each endoscopist had treated a mean of four cases during the previous year (mean total experience 11 ESDs) bringing a total of 510 ESDs across all European centers that responded (197 during the past year). Lesions were located in the antrum in 35 % of cases; 39 % were Paris classification IIa, 22 % IIa + b, and 18 % IIa + c. Overall, the average of mean lesion diameter was 15.7 mm (range 1 - 70.0 mm). Most cases were non-invasive high-grade intraepithelial neoplasia (44 %) or adenocarcinoma (36 %). An insulated-tipped knife (1 or 2) was used in 70 % of procedures and an average of the mean duration of procedures was 108 minutes. In all, 78 % of lesions were removed en bloc with an R0 rate of 77 %. Endoscopists experienced major complications (perforation or major bleeding) in 13 % of cases.

ESD in Europe seems to be performed at a few centers, with most endoscopists performing a low number of procedures, achieving a high rate of efficacy and a moderate rate of major complications. However, as a potential selection bias may have occurred, multicenter registries should be conducted to help address the problem of dissemination of this technique.