Endoscopic Submucosal Dissection in North America: A Large Prospective Multicenter Study.
EMR
Endoscopic Mucosal Resection
Endoscopic Submucosal Dissection
Gastrointestinal Neoplasms
Polyps
Journal
Gastroenterology
ISSN: 1528-0012
Titre abrégé: Gastroenterology
Pays: United States
ID NLM: 0374630
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
14
08
2020
revised:
22
01
2021
accepted:
15
02
2021
pubmed:
22
2
2021
medline:
12
1
2022
entrez:
21
2
2021
Statut:
ppublish
Résumé
Endoscopic submucosal dissection (ESD) in Asia has been shown to be superior to endoscopic mucosal resection (EMR) and surgery for the management of selected early gastrointestinal cancers. We aimed to evaluate technical outcomes of ESD in North America. We conducted a multicenter prospective study on ESD across 10 centers in the United States and Canada between April 2016 and April 2020. End points included rates of en bloc resection, R0 resection, curative resection, adverse events, factors associated with failed resection, and recurrence post-R0 resection. Six hundred and ninety-two patients (median age, 66 years; 57.8% were men) underwent ESD (median lesion size, 40 mm; interquartile range, 25-52 mm) for lesions in the esophagus (n = 181), stomach (n = 101), duodenum (n = 11), colon (n = 211) and rectum (n = 188). En bloc, R0, and curative resection rates were 91.5%, 84.2%, and 78.3%, respectively. Bleeding and perforation were reported in 2.3% and 2.9% of the cases, respectively. Only 1 patient (0.14%) required surgery for adverse events. On multivariable analysis, severe submucosal fibrosis was associated with failed en bloc, R0, and curative resection and higher risk for adverse events. Overall recurrence was 5.8% (31 of 532) at a mean follow-up of 13.3 months (range, 1-60 months). In this large multicenter prospective North American experience, we demonstrate that ESD can be performed safely, effectively, and is associated with a low recurrence rate. The technical resection outcomes achieved in this study are in line with the current established consensus quality parameters and further support the implementation of ESD for the treatment of select gastrointestinal neoplasms; ClinicalTrials.gov, Number: NCT02989818.
Sections du résumé
BACKGROUND AND AIMS
Endoscopic submucosal dissection (ESD) in Asia has been shown to be superior to endoscopic mucosal resection (EMR) and surgery for the management of selected early gastrointestinal cancers. We aimed to evaluate technical outcomes of ESD in North America.
METHODS
We conducted a multicenter prospective study on ESD across 10 centers in the United States and Canada between April 2016 and April 2020. End points included rates of en bloc resection, R0 resection, curative resection, adverse events, factors associated with failed resection, and recurrence post-R0 resection.
RESULTS
Six hundred and ninety-two patients (median age, 66 years; 57.8% were men) underwent ESD (median lesion size, 40 mm; interquartile range, 25-52 mm) for lesions in the esophagus (n = 181), stomach (n = 101), duodenum (n = 11), colon (n = 211) and rectum (n = 188). En bloc, R0, and curative resection rates were 91.5%, 84.2%, and 78.3%, respectively. Bleeding and perforation were reported in 2.3% and 2.9% of the cases, respectively. Only 1 patient (0.14%) required surgery for adverse events. On multivariable analysis, severe submucosal fibrosis was associated with failed en bloc, R0, and curative resection and higher risk for adverse events. Overall recurrence was 5.8% (31 of 532) at a mean follow-up of 13.3 months (range, 1-60 months).
CONCLUSIONS
In this large multicenter prospective North American experience, we demonstrate that ESD can be performed safely, effectively, and is associated with a low recurrence rate. The technical resection outcomes achieved in this study are in line with the current established consensus quality parameters and further support the implementation of ESD for the treatment of select gastrointestinal neoplasms; ClinicalTrials.gov, Number: NCT02989818.
Identifiants
pubmed: 33610532
pii: S0016-5085(21)00424-8
doi: 10.1053/j.gastro.2021.02.036
pmc: PMC8783061
mid: NIHMS1769666
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02989818']
Types de publication
Evaluation Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2317-2327.e2Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Informations de copyright
Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Gastrointest Endosc. 2017 Jul;86(1):74-86.e17
pubmed: 28254526
Dig Dis Sci. 2017 Dec;62(12):3325-3335
pubmed: 29043596
Gastrointest Endosc. 2008 Oct;68(4 Suppl):S3-47
pubmed: 18805238
Gastrointest Endosc. 2019 May;89(5):1045-1053
pubmed: 30716306
Ann Transl Med. 2018 Jul;6(13):262
pubmed: 30094248
Intest Res. 2016 Oct;14(4):358-364
pubmed: 27799887
Gut. 2018 Aug;67(8):1464-1474
pubmed: 29208675
Curr Treat Options Gastroenterol. 2018 Mar;16(1):41-57
pubmed: 29435819
Gastrointest Endosc. 2018 Jun;87(6):1383-1393
pubmed: 28993137
Dig Endosc. 2020 Sep;32(6):851-860
pubmed: 31797470
Gut. 2018 Nov;67(11):1965-1973
pubmed: 28988198
Clin Gastroenterol Hepatol. 2016 Feb;14(2):271-8.e1-2
pubmed: 26364679
Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3-43
pubmed: 14652541
Dig Endosc. 2016 Jan;28(1):3-15
pubmed: 26234303
Clin Gastroenterol Hepatol. 2019 May;17(6):1019-1028
pubmed: 30267866
Gastrointest Endosc. 2010 Mar;71(3):446-54
pubmed: 20189503
Gastroenterology. 2017 Sep;153(3):732-742.e1
pubmed: 28583826
Dig Endosc. 2019 Jan;31(1):94-100
pubmed: 30022521
Am J Gastroenterol. 2020 Mar;115(3):435-464
pubmed: 32058340
Clin Gastroenterol Hepatol. 2019 Jan;17(1):16-25.e1
pubmed: 30077787
Gastrointest Endosc. 2020 Nov;92(5):1016-1025
pubmed: 32504699
Endoscopy. 2019 Oct;51(10):980-992
pubmed: 31470448
Gastrointest Endosc. 2017 Oct;86(4):600-607
pubmed: 27688205
Gastrointest Endosc. 2018 Jan;87(1):243-250.e2
pubmed: 28408327
Dig Endosc. 2015 May;27(4):417-434
pubmed: 25652022
Gastrointest Endosc. 2019 Mar;89(3):533-544
pubmed: 30273589
Gastrointest Endosc. 2016 Jun;83(6):1248-57
pubmed: 26608129
Am J Gastroenterol. 2019 Nov;114(11):1802-1810
pubmed: 31634261
Gut. 2000 Aug;47(2):251-5
pubmed: 10896917
Gastrointest Endosc. 2019 Mar;89(3):479-481
pubmed: 30784495
Gastrointest Endosc. 2015 Jan;81(1):204-13
pubmed: 25440686
Endoscopy. 2015 Sep;47(9):829-54
pubmed: 26317585