Endoscopic submucosal dissection of neoplasms and early cancers in the upper gastrointestinal tract – Efficacy and safety of ESD in a non-academic center

The endoscopic submucosal dissection (ESD) is already a standard technique in Japan for the resection of large gastrointestinal neoplasms at an early stage. ESD is a further development of the endoscopic mucosal resection (EMR). Compared to EMR it has a higher en-bloc resection rate that allows an accurate histopathological assessment and leads to lower local recurrence rates. For the indication of ESD the neoplasms need to fulfill the criteria of node negative cancer (extended Ono-criteria). Long-term outcomes for lesions within the criteria of node negative cancers were reported as comparable to those after surgery.

A total of 40 ESDs in the stomach (n = 35) and the esophagus (n = 5) were observed. The mean patient age was 68 years (19 men, 21 women). Data was analyzed for en-bloc- and R0-resection-rate, complications, local recurrence and rate of successful interventions. An intervention was considered successful, if the resected specimen met the criteria of a node negative cancer and if a complete microscopic resection was performed.

ESD is an effective technique of treating neoplasms and early cancers in the upper gastrointestinal tract. In the majority of cases a surgery could be prevented. However, ESD requires highly skilled endoscopists, considering the high rates of serious complications.