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Updated: Jul 11, 2025

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Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery-A Multicenter

Philipp Pimingstorfer1, Matthias Biebl2, Matus Gregus3

  • 1Kepler Universitätsklinikum, 4020 Linz, Austria.

Journal of Clinical Medicine
|November 14, 2023
PubMed
Summary

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Endoscopic submucosal dissection (ESD) for upper GI cancers offers surgical-like results. Rescue surgery after non-curative ESD is safe and effective, with outcomes improving over time.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Endoscopy

Background:

  • Endoscopic submucosal dissection (ESD) is a standard treatment for early upper gastrointestinal (GI) cancers.
  • ESD outcomes are comparable to traditional surgery.
  • Rescue surgery after non-curative ESD shows promising results.

Purpose of the Study:

  • To evaluate the outcomes of ESD in the upper GI tract.
  • To assess the effectiveness of rescue surgery following non-curative ESD.
  • To analyze data from Linz, Austria (2009-2023).

Main Methods:

  • Retrospective analysis of 193 ESD procedures (104 esophageal, 89 gastric).
  • Evaluation of curative ESD criteria based on established guidelines.
  • Assessment of reasons for non-curative ESD and subsequent rescue surgery decisions.
Keywords:
ESD outcomeESD upper GIrescue surgery

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Main Results:

  • Curative ESD rates: 56.7% for esophageal, 69.7% for gastric lesions.
  • Non-curative ESD reasons: technical failure (13.3% esophageal, 25.9% gastric) and oncological failure (86.7% esophageal, 74.1% gastric).
  • Rescue surgery performed in ~48% of indicated cases, often deferred due to comorbidities.

Conclusions:

  • ESD outcomes in the upper GI tract align with international literature.
  • Non-curative ESD does not negatively impact surgical outcomes.
  • Indications for rescue surgery in oncological failure remain complex, though outcomes are favorable and the ESD learning curve shows improvement.