Safety and Efficacy of Gastric Endoscopic Submucosal Dissection in a Non-academic Western Center

Endoscopic submucosal dissection (ESD) is a minimally invasive technique used to treat gastrointestinal neoplasms. Lower incidence of gastric lesions results in fewer studies of gastric ESD in the West. We aimed to show the safety and efficacy of gastric ESD in a non-academic center as compared to the available studies, while adhering to established international guidelines.

We retrospectively analyzed gastric ESDs in our center between June 2015 and December 2024. Included were precancerous lesions, early gastric cancers (EGCs), neuroendocrine neoplasias, and subepithelial lesions. Patient demographics, lesion characteristics, procedural details, adverse events, and treatment outcomes were analyzed. Primary study outcomes included rates of complete R0 resection (horizontal and vertical margins free of GI neoplasia on histopathology), curative resection in EGCs (R0 with no lymphovascular invasion, as defined by JGES criteria), and adverse events. Secondary outcomes were recurrence and diagnostic discrepancies.

One hundred gastric ESDs were performed in 91 patients. Conversion to hybrid ESD/EMR was done in six cases. In one early case, ESD was aborted after intraprocedural perforation. R0 resection rates for all lesions were 91%, 100% for low-grade dysplasias, 100% for high-grade dysplasias, 80.9% for EGCs, and 100% for other indications. Curative resection was achieved in 78.7% of EGCs. Adverse events occurred in 11 (11%) cases. During the mean follow-up period of 21.8 ± 24.0 months, recurrence occurred in four of 73 patients with follow-up data (5.5%).

Our results demonstrate ESD as a safe and effective option for gastric lesions in non-academic Western centers.