Brief Article
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World J Gastroenterol. Mar 28, 2013; 19(12): 1953-1961
Published online Mar 28, 2013. doi: 10.3748/wjg.v19.i12.1953
Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract
Andrzej Białek, Anna Wiechowska-Kozłowska, Jan Pertkiewicz, Katarzyna Karpińska, Wojciech Marlicz, Piotr Milkiewicz, Teresa Starzyńska
Andrzej Białek, Wojciech Marlicz, Teresa Starzyńska, Gastroenterology Department, Pomeranian Medical University, 71-242 Szczecin, Poland
Anna Wiechowska-Kozłowska, Piotr Milkiewicz, Department of Endoscopy, Ministry of Internal Affairs Hospital, 70-382 Szczecin, Poland
Jan Pertkiewicz, Endotherapy Ltd, 02-091 Warsaw, Poland
Katarzyna Karpińska, Cell Pathology Department, Pomeranian Medical University, 71-242 Szczecin, Poland
Piotr Milkiewicz, Liver Unit, Pomeranian Medical University, 71-242 Szczecin, Poland
Author contributions: Białek A, Wiechowska-Kozłowska A, Pertkiewicz J, Milkiewicz P and Starzyńska T designed research; Białek A, Wiechowska-Kozłowska A, Pertkiewicz J, Karpińska K, Milkiewicz P and Starzyńska T performed research; Białek A, Wiechowska-Kozłowska A, Marlicz W and Milkiewicz P analyzed data; Białek A, Wiechowska-Kozłowska A, Milkiewicz P and Starzyńska T wrote the paper.
Correspondence to: Andrzej Bialek, MD, Gastroenterology Department, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-242 Szczecin, Poland. bialekab@pam.szczecin.pl
Telephone: +48-91-4253211 Fax: +48-91-4253211
Received: October 27, 2012
Revised: December 20, 2012
Accepted: January 11, 2013
Published online: March 28, 2013
Processing time: 153 Days and 19.9 Hours
Abstract

AIM: To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center.

METHODS: We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ2 tests for dichotomous variables.

RESULTS: Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm2. The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm2vs 17.9 min/cm2, P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm2) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm2, P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%).

CONCLUSION: ESD is an effective and safe method for resection of neoplastic lesions with low recurrence. Speed and the R0 resection rate increased after 50 procedures.

Keywords: Endoscopic submucosal dissection; Gastrointestinal neoplasms; Gastrointestinal stromal tumors; Treatment