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Endoscopic Submucosal Dissection in North America: A Large Prospective Multicenter Study.

Peter V Draganov1, Hiroyuki Aihara2, Michael S Karasik3

  • 1Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.

Gastroenterology
|February 21, 2021
PubMed

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Summary
This summary is machine-generated.

Endoscopic submucosal dissection (ESD) is effective for early gastrointestinal cancers in North America, achieving high resection rates with low adverse events. This study supports its wider implementation for selected neoplasms.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Endoscopic Procedures

Background:

  • Endoscopic submucosal dissection (ESD) is a minimally invasive technique for early gastrointestinal cancers.
  • Previous studies, primarily from Asia, suggest ESD's superiority over endoscopic mucosal resection (EMR) and surgery.
  • The adoption and outcomes of ESD in North America required evaluation.

Purpose of the Study:

  • To assess the technical outcomes of endoscopic submucosal dissection (ESD) in North America.
  • To evaluate the safety, efficacy, and recurrence rates of ESD for gastrointestinal neoplasms.
  • To compare North American ESD outcomes with established international quality parameters.

Main Methods:

  • A multicenter prospective study involving 10 centers in the United States and Canada (April 2016 - April 2020).
Keywords:
EMREndoscopic Mucosal ResectionEndoscopic Submucosal DissectionGastrointestinal NeoplasmsPolyps

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  • Inclusion of 692 patients undergoing ESD for lesions in the esophagus, stomach, duodenum, colon, and rectum.
  • Key endpoints included en bloc, R0, and curative resection rates, adverse events, and recurrence.

    • Main Results:

    • High rates of en bloc (91.5%), R0 (84.2%), and curative resection (78.3%) were achieved.
    • Low rates of bleeding (2.3%) and perforation (2.9%) were observed, with only 1 patient requiring surgery.
    • Severe submucosal fibrosis was linked to failed resections and adverse events; recurrence rate was 5.8%.

    Conclusions:

    • Endoscopic submucosal dissection (ESD) is a safe and effective procedure in North America for selected early gastrointestinal cancers.
    • The achieved technical outcomes align with international consensus quality standards.
    • These findings support the broader implementation of ESD in North American clinical practice.