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Endoscopy. 2015 Sep;47(9):775-83. doi: 10.1055/s-0034-1391844. Epub 2015 Mar 31.

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study.

Author information

1
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
2
Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan.
3
Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.
4
Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan.
5
Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan.
6
Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan.
7
Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan.
8
Department of Gastroenterology, Minoh City Hospital, Minoh, Japan.
9
Department of Gastroenterology, Itami City Hospital, Itami, Japan.
10
Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan.
11
Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan.
12
Department of Gastroenterology, Osaka Kosei-nenkin Hospital, Osaka, Japan.

Abstract

BACKGROUND AND STUDY AIMS:

The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals.

PATIENTS AND METHODS:

Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed.

RESULTS:

The median tumor size was 18 mm (range 2 - 85 mm). The median procedure time was 90 minutes (range 12 - 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % - 98.1 %) and 84.5 % (95 %CI 80.5 % - 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % - 7.9 %), 1.6 % (95 %CI 0.7 % - 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % - 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 - 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections.

CONCLUSIONS:

Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

Comment in

PMID:
25826277
DOI:
10.1055/s-0034-1391844
[Indexed for MEDLINE]

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