Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer--initial experience of a western center

Abstract

Background: Endoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection.

Objective: To evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University.

Materials and methods: Twenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications.

Results: Sixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6-3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20-160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6-30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20-150 min)

Conclusion: The endoscopic submucosal dissection technique was feasible in our service with a high success rate.

Keywords: Endoscopic mucosal; early esophageal cancer; early gastric cancer; endoscopic submucosal dissection; endoscopy; resection.

Figure 1

Endoscopic submucosal dissection of a gastric adenocarcinoma (IIa+IIc). A- Marking of the lesion. B- Circumferential cutting around the entire lesion. C- Submucosal dissection of the lesion with the IT-knife. D- Complete resection of the lesion. E- ESD specimen (one piece).