Outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms: a multicenter North
Rishi Subrahmanyan1, Hiroyuki Aihara2, Anand Kumar3
1Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Background And Aims:
Endoscopic submucosal dissection (ESD) is recommended as the standard of care for treating superficial esophageal squamous neoplasms (ESNs). However, the data in the Western world are limited. This study aims to describe the outcomes of ESD for ESN in North America.
Methods:
We conducted a multicenter retrospective analysis of patients who underwent ESD for superficial ESN at 13 North American academic centers. The primary outcomes were the rates of en bloc, R0, and curative resection. Patient demographics, technical outcomes, clinical outcomes, and adverse events (AEs) were also reported.
Results:
A total of 150 patients (39% female, mean age 70 ± 10 years) underwent ESD to treat superficial ESN with an average tumor size of 36.6 ± 27.0 mm. En bloc resection rates for all, low-grade dysplasia (LGD)/high-grade dysplasia (HGD), M1/M2, and M3/submucosal (SM)1 lesions were 97%, 97%, 100%, and 94%, respectively. R0 resection rates for all, LGD/HGD, M1/M2, and M3/SM1 lesions were 73%, 84%, 89%, and 70%, respectively. Curative resection rates for all, LGD/HGD, M1/M2, and M3/SM1 lesions were 55%, 84%, 86%, and 61%, respectively. AEs were observed in 25 patients (16.6%). The median follow-up time was 15.7 months (IQR, 6.1-28.0). Local recurrence occurred in 12 (8.0%) cases, 3 (2%) cases from curative resection, and 9 (6%) cases in noncurative resection (P = .04). Metastasis occurred in 8 (5.3%) of all included cases and was only evident in noncurative resections. During this period, 21 (14.0%) patients died of nonesophageal squamous cell carcinoma (ESCC)-related causes, and 7 (4.7%) patients died of ESCC.
Conclusions:
ESD is a safe and effective treatment for superficial ESN with a low recurrence rate in lesions that meet the standard criteria for curative resection.
