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

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).
• 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.