Endoscopic Submucosal Dissection Outcomes for Early Gastric Lesions in North America
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Endoscopic Submucosal Dissection Outcomes for Early Gastric Lesions in North America

Vanessa M. Shami, MD, FASGE, reviewing Ngamruengphong S, et al. Clin Gastroenterol Hepatol 2020 Jun 18.

There are sufficient data in Asia to demonstrate that endoscopic submucosal dissection (ESD) has equivalent outcomes to surgical intervention for early gastric cancer (EGC). Moreover, studies have suggested shorter length of stay, lower cost, and better quality of life for patients who undergo ESD of EGCs. The American Gastroenterological Association (AGA) recommends ESD to be the first-line choice for visible, endoscopically resectable, superficial, gastric neoplasias. However, there has yet to be any data from a North American cohort to validate Asian literature.

For this study, data was accrued from 25 centers from 2010 through 2019 for 277 patients who had follow-up information, including a median interval between initial ESD and last clinical or endoscopic evaluation at 364 days. Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection were 92% and 82%, respectively, for all lesions and 94% and 75%, respectively, for EGCs. Complications including perforation occurred in 6.6% of patients, and 82% were treated endoscopically. Delayed bleeding occurred in 2.6% of patients. There were local recurrences in 3.9% of cases; all occurred after noncurative ESD resection.

Vanessa M. Shami, MD, FASGE

COMMENT

This study confirms the AGA stance that ESD should be the first-line choice for EGCs and careful surveillance should be necessary to identify metachronous lesions. The challenge is due to the lower incidence of gastric neoplasias in Western countries (this study captured less than 350 cases in the last decade) and the technical difficulty of ESD. As ESD quickly becomes the standard of care for early gastric lesions, it is important for gastroenterologists to recognize EGCs and refer to the appropriate institutions.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Ngamruengphong S, Ferri L, Aihara H, et al. Efficacy of endoscopic submucosal dissection for superficial gastric neoplasia in a large cohort in North America. Clin Gastroenterol Hepatol 2020 Jun 18. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.06.023)

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