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Endoscopic submucosal dissection safe, effective in Western cohort
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Patients who cannot undergo surgery for early gastric cancers could benefit from local disease control with endoscopic submucosal dissection, according to study results.
Michael J. Bourke, of the department of gastroenterology and hepatology at Westmead Hospital in Sydney, Australia, and colleagues wrote in Gastrointestinal Endoscopy that eastern centers have had a lot of success using endoscopic submucosal dissection (ESD) in early gastric cancers (EGC), achieving en-bloc and R0 resection rates of as high as 97% and 93%, respectively. However, western centers have been slow to adopt ESD.
“The situation in Western centers is very different. EGC is much less common, ESD is not widely available, and there are few opportunities to train in the technique,” they wrote. “In addition, although a growing number of studies now address the application of the absolute criteria to Western patients, the expanded criteria for ESD of [precursor] EGC remain relatively untested in this context.”
Bourke and colleagues wrote that previous studies have used the Japanese gastric cancer treatment guidelines for assessment of endoscopic score. These guidelines do not use the internationally accepted Vienna criteria for the reporting of dysplasia, which are used in western centers.
Researchers collected prospective data on all precursor lesions undergoing ESD at single expert endoscopy center. They compared outcomes among all lesions (n = 135) by satisfying the Japanese absolute and expanded criteria, lesions outside the criteria and specimens that contained only low-grade dysplasia.
Over 71 months, 121 patients underwent ESD, in which the rates of en-bloc and R0 resection were 94.8% and 86.7%, respectively.
Investigators found that 107 lesions met the absolute or expanded criteria for endoscopic cure (79.2%). Of the 26 lesions that fell outside criteria for cure underwent surgery after ESD with residual tumor detected in 3 specimens.
Bourke and colleagues wrote that 15 patients with outside criteria precursor lesions did not undergo surgery due to frailty or their expressed wishes, and 11 of those patients have undergone first surveillance. Just one of those patients have experienced endoscopic and histologic recurrence.
“Patients with outside criteria resections, who either decline or are too frail for surgery, may benefit from ESD for local disease control and potential cure,” they wrote. “Application of internationally accepted pathologic reporting criteria in large prospective Western studies of ESD for [precursor lesion] is required to better define surveillance guidelines and patient outcomes, particularly in the group of patients with isolated low-grade dysplasia or high-grade dysplasia.” – by Alex Young
Disclosures: Bourke reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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