EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN AN EUROPEAN CENTER

Introduction: Endoscopic submucosal dissection (ESD) allows en bloc resection of gastrointestinal lesions but demands skilful endoscopic teams. Comparing to endoscopic mucosal resection, it is associated with prolonged procedure time and increased risks of complications. European reports on ESD are scarce and limited in size. Aims & Methods: In this prospective study, we aim to evaluate the efficacy and safety of this technique in our center. Consecutive patients with gastrointestinal lesions with indication for ESD were invited to participate. The study was approved by the Ethical Committee of our Institution and each patient gave written inform consent. All ESDs were performed in the endoscopy unit under propofol sedation using IT-knife 2, IT-knife nano and Dual-knife according to lesions localization. Follow-up endoscopies were performed 2 months after ESD and subsequently each 6 – 12 months, according to pathology result. Results: 104 patients (45 female, mean age 63,7 ± 13 years-old) were invited to participate. The corresponding 109 lesions were located in the esophagus (n = 5), stomach (n = 77), duodenum (n = 3), colon (n = 6) and rectum (n = 18). En bloc resection and R0 resection were obtained in 94% and 81% of cases, respectively. The specimens size ranged between 17 – 140 mm (mean 36 ± 18 mm), corresponding to lesions with 9 – 105 mm (mean 28 ± 18 mm). The median procedure length was 94 ± 80 minutes. Six lesions were subepitelial, being the remaining epithelial. The most frequent pathological results were low-grade dysplasia (n = 35), high-grade dysplasia (n = 26), intramucosal adenocarcinoma (n = 14), invasive carcinoma (n = 7). Two patients had acute surgery due to perforation (n = 1) and bleeding (n = 1). One patient had emphysema treated conservatively. Six patients had delayed bleeding. In 69% of cases ESD was performed in an outpatient basis, being all patients discharged in up to 7 days. Conclusión: In this prospective study, ESD enabled accurate resection, with low complications rate and no mortality.