Introduction of endoscopic submucosal dissection in the West

Table 5 Major Western endoscopic submucosal dissection series for early gastric cancer n (%)

	Guideline criteria	Expanded criteria	Out of indication	P-value
179 subjects	53 subjects	87 subjects	30 subjects
Post ESD endoscopic follow-up	53/53 (100)	84/87 (97)	27/39 (69)	< 0.001
Follow-up median (mo)	51	56	36	NS
Curative resection	47/53 (89)	65/87 (75)	0	0.07
Local recurrence	0	4/84 (5)	3/27 (11)	0.06
Post ESD surgery	0	3/87 (3)	12/39 (31)	< 0.001
Metastases	0	1/84 (1)	3/27 (11)	0.005
Gastric cancer mortality	0	0	3 (8)	0.004
All-cause mortality	7 (13)	16 (18)	11 (28)	0.19

One hundred and seventy-nine ESD procedures for EGC over 12 years-about 15/year (modest compared to Asian centers). This Western center’s learning curve: 1^st block of ESD’s (1-96) compared to 2^nd block (97-191). R0 resection increased from 60% (57/96) to 93% (88/95) (P < 0.001). Median procedure time decreased from 148 to 110 min (P < 0.001). Modified from Probst et al[25]. ESD: Endoscopic submucosal dissection; NS: Not significant; EGC: Early gastric cancer.