O1 Efficacy and safety of endoscopic submucosal dissection of early gastric neoplasia in the West: a multicentre prospective european study
IntroductionEndoscopic submucosal dissection is considered the first line treatment for early gastric neoplasia, and extensive data is reported from the Far East demonstrating its efficacy and safety even in expanded criteria in the Japanese guidelines. Data from the west is still limited to mostly...
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| Vydáno v: | Gut Ročník 71; číslo Suppl 1; s. A1 |
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BMJ Publishing Group Ltd and British Society of Gastroenterology
01.06.2022
BMJ Publishing Group LTD |
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| Abstract | IntroductionEndoscopic submucosal dissection is considered the first line treatment for early gastric neoplasia, and extensive data is reported from the Far East demonstrating its efficacy and safety even in expanded criteria in the Japanese guidelines. Data from the west is still limited to mostly small series from single centres. In this study, we describe a large multicentre, European cohort and review outcome and safety of gastric ESD in the hands of western experts in the light of the latest Japanese indication criteria.MethodsThis is a prospective observational cohort study conducted in four large endoscopy referral centres in four European countries. Study included patients referred for gastric ESD in participating centres in the period from 2009 to 2020. Data was prospectively collected on patient demographics, lesion characteristics, procedure details and outcomes of endoscopic treatment. Indications for endoscopic resection were categorised according to the latest Japanese guidelines. Patients were followed up clinically and endoscopically as per standard protocols. Statistical analysis using logistic regression was performed.ResultsA total of 340 patients were included. Mean age was 72 years and 55.6% were males. Absolute criteria were fulfilled in 74.4% of patients. Median follow up duration was 39 months. Post resection histology was adenocarcinoma, HGD, LGD and other in 52.5%, 20.7%, 16.8% and 10.0% respectively. Poor differentiation was reported in 14.6% of adenocarcinoma. Early bleeding, delayed bleeding and perforation occurred in 5.3%, 3.2% and 2.1% respectively. En bloc, R0 and recurrence rates were 93.8%, 82.9% and 6.7%. Relative indication was independently associated with R1 outcome (OR 3.90, 95% CI 1.64, 9.24, P value 0.002). Table (1) below summarises the outcomes and complications.Abstract O1 Table 1Outcomes and complications of endoscopic resection of early gastric neoplasia n=340 Outcome N Category Number (%) En-bloc 340 Yes 319 (93.8%) Margins 340 R0 282 (82.9%) Recurrence (3–6 months) 340 Yes 14 (4.1%) Delayed Recurrence 340 Yes 9 (2.6%) Bleeding 340 Early 18 (5.3%) Delayed 11 (3.2%) Management of bleeding 29 Conservative-PPI 4 (13.8%) Endoscopic 23 (79.3%) Radiologic 1 (3.5%) Surgical 1 (3.5%) Transfusion required 29 Yes 9 (31.0%) Perforation 340 Yes 7 (2.1%) Management ofPerforation 7 Conservative 1 (14.3%) Endoscopic 5 (71.4%) Surgery 1 (14.3%) ConclusionThis is the largest, multicentre, European cohort suggesting ESD is safe and effective treatment of early gastric neoplasia in the western setting. Our data suggests the Japanese expanded and relative criteria for gastric ESD may be safe in the western practice; however more data is needed to fully characterise this group and inform future selection and surveillance guidelines. |
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| AbstractList | IntroductionEndoscopic submucosal dissection is considered the first line treatment for early gastric neoplasia, and extensive data is reported from the Far East demonstrating its efficacy and safety even in expanded criteria in the Japanese guidelines. Data from the west is still limited to mostly small series from single centres. In this study, we describe a large multicentre, European cohort and review outcome and safety of gastric ESD in the hands of western experts in the light of the latest Japanese indication criteria.MethodsThis is a prospective observational cohort study conducted in four large endoscopy referral centres in four European countries. Study included patients referred for gastric ESD in participating centres in the period from 2009 to 2020. Data was prospectively collected on patient demographics, lesion characteristics, procedure details and outcomes of endoscopic treatment. Indications for endoscopic resection were categorised according to the latest Japanese guidelines. Patients were followed up clinically and endoscopically as per standard protocols. Statistical analysis using logistic regression was performed.ResultsA total of 340 patients were included. Mean age was 72 years and 55.6% were males. Absolute criteria were fulfilled in 74.4% of patients. Median follow up duration was 39 months. Post resection histology was adenocarcinoma, HGD, LGD and other in 52.5%, 20.7%, 16.8% and 10.0% respectively. Poor differentiation was reported in 14.6% of adenocarcinoma. Early bleeding, delayed bleeding and perforation occurred in 5.3%, 3.2% and 2.1% respectively. En bloc, R0 and recurrence rates were 93.8%, 82.9% and 6.7%. Relative indication was independently associated with R1 outcome (OR 3.90, 95% CI 1.64, 9.24, P value 0.002). Table (1) below summarises the outcomes and complications.Abstract O1 Table 1Outcomes and complications of endoscopic resection of early gastric neoplasia n=340Outcome N Category Number (%) En-bloc 340 Yes 319 (93.8%) Margins 340 R0 282 (82.9%) Recurrence (3–6 months) 340 Yes 14 (4.1%) Delayed Recurrence 340 Yes 9 (2.6%) Bleeding 340 Early 18 (5.3%) Delayed 11 (3.2%) Management of bleeding 29 Conservative-PPI 4 (13.8%) Endoscopic 23 (79.3%) Radiologic 1 (3.5%) Surgical 1 (3.5%) Transfusion required 29 Yes 9 (31.0%) Perforation 340 Yes 7 (2.1%) Management of Perforation 7 Conservative 1 (14.3%) Endoscopic 5 (71.4%) Surgery 1 (14.3%) ConclusionThis is the largest, multicentre, European cohort suggesting ESD is safe and effective treatment of early gastric neoplasia in the western setting. Our data suggests the Japanese expanded and relative criteria for gastric ESD may be safe in the western practice; however more data is needed to fully characterise this group and inform future selection and surveillance guidelines. IntroductionEndoscopic submucosal dissection is considered the first line treatment for early gastric neoplasia, and extensive data is reported from the Far East demonstrating its efficacy and safety even in expanded criteria in the Japanese guidelines. Data from the west is still limited to mostly small series from single centres. In this study, we describe a large multicentre, European cohort and review outcome and safety of gastric ESD in the hands of western experts in the light of the latest Japanese indication criteria.MethodsThis is a prospective observational cohort study conducted in four large endoscopy referral centres in four European countries. Study included patients referred for gastric ESD in participating centres in the period from 2009 to 2020. Data was prospectively collected on patient demographics, lesion characteristics, procedure details and outcomes of endoscopic treatment. Indications for endoscopic resection were categorised according to the latest Japanese guidelines. Patients were followed up clinically and endoscopically as per standard protocols. Statistical analysis using logistic regression was performed.ResultsA total of 340 patients were included. Mean age was 72 years and 55.6% were males. Absolute criteria were fulfilled in 74.4% of patients. Median follow up duration was 39 months. Post resection histology was adenocarcinoma, HGD, LGD and other in 52.5%, 20.7%, 16.8% and 10.0% respectively. Poor differentiation was reported in 14.6% of adenocarcinoma. Early bleeding, delayed bleeding and perforation occurred in 5.3%, 3.2% and 2.1% respectively. En bloc, R0 and recurrence rates were 93.8%, 82.9% and 6.7%. Relative indication was independently associated with R1 outcome (OR 3.90, 95% CI 1.64, 9.24, P value 0.002). Table (1) below summarises the outcomes and complications.Abstract O1 Table 1Outcomes and complications of endoscopic resection of early gastric neoplasia n=340 Outcome N Category Number (%) En-bloc 340 Yes 319 (93.8%) Margins 340 R0 282 (82.9%) Recurrence (3–6 months) 340 Yes 14 (4.1%) Delayed Recurrence 340 Yes 9 (2.6%) Bleeding 340 Early 18 (5.3%) Delayed 11 (3.2%) Management of bleeding 29 Conservative-PPI 4 (13.8%) Endoscopic 23 (79.3%) Radiologic 1 (3.5%) Surgical 1 (3.5%) Transfusion required 29 Yes 9 (31.0%) Perforation 340 Yes 7 (2.1%) Management ofPerforation 7 Conservative 1 (14.3%) Endoscopic 5 (71.4%) Surgery 1 (14.3%) ConclusionThis is the largest, multicentre, European cohort suggesting ESD is safe and effective treatment of early gastric neoplasia in the western setting. Our data suggests the Japanese expanded and relative criteria for gastric ESD may be safe in the western practice; however more data is needed to fully characterise this group and inform future selection and surveillance guidelines. |
| Author | Maselli, Roberta Groth, Stefan Alkandari, Asma A Invernizzi, Martina Kaminski, Michal F Bhandari, Pradeep Subhramaniam, Sharmila Kandiah, Kesavan Seewald, Stefan Pilonis, Nastazja D Hossain, Ejaz Galtieri, Piera Alessia Spadaccini, Marco Abdelrahim, Mohamed Repici, Alessandro |
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| Snippet | IntroductionEndoscopic submucosal dissection is considered the first line treatment for early gastric neoplasia, and extensive data is reported from the Far... |
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| SubjectTerms | Adenocarcinoma Bleeding Cancer Endoscopy Gastric cancer Oral presentations Patients Safety Statistical analysis |
| Title | O1 Efficacy and safety of endoscopic submucosal dissection of early gastric neoplasia in the West: a multicentre prospective european study |
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