Endoscopic Submucosal Dissection (ESD): Experience from a Tertiary Care Center in Southern India

Introduction: ESD is a well-established resection technique for removal of gastrointestinal tumors. We analyzed the clinical profile and outcomes in patients who underwent ESD in a tertiary care center in Southern India.

Methods: Retrospective cohort study involving the patients who underwent ESD from July 2019 to December 2023 in our institute was done. Patients underwent OGDscopy/colonoscopy, endoscopic ultrasound, and biopsy if needed prior to procedure.

Results: A total of 110 patients underwent the procedure, 57 (52%) are male and 53 (48%) are female. Mean age was 65.5 ± 12.1 years. Mean hospital stay was 4.16 ± 1.9 days. Largest lesion excised was 11 cm. Location of the lesion and biopsy details are tabulated ([Table 1]).

Lateral margins were involved in only 9, focal dysplasia was seen in 18, margins were clear in 83 (of which margin clearance of <1 mm was in 12). Deep margins were involved in 12 (3 had focal involvement), in the rest margins were clear in 98 (of which margin clearance of <1 mm was seen in 23).

Lymphovascular invasion was seen in only 9 (8%) requiring further management (surgical/oncological). Even in patients with deep margin involvement, almost 50% were managed conservatively and are on follow-up.

6 (5%) had circumferential lesions, of which one was removed piece-meal. On follow-up, 2 patients had stricture development requiring dilatation.

Complications: delayed bleed was seen in 5 patients, requiring endoscopic interventions, and muscle injury was seen in 15 patients managed with hemoclips.

Conclusion: ESD is feasible and effective for management of GI tumors with reduced hospital stay and low complication rate. Patient selection is very important in achieving clinical success.

Table 1

Publication History

Article published online:
22 April 2024