Lim SXY, Ratcliffe E, Wiltshire R, Whiteway JGS, McGrath S, Sultan J, Prasad N, Assadsangabi A, Britton J, Ang YS. Long-term outcomes of endoscopic submucosal dissection for gastric dysplasia and early neoplasia in a United Kingdom Caucasian population. World J Gastrointest Endosc 2025; 17(3): 102694 [DOI: 10.4253/wjge.v17.i3.102694]
Corresponding Author of This Article
Yeng S Ang, MD, Professor, Department of Endoscopy and Gastroenterology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom. yeng.ang@nca.nhs.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2025; 17(3): 102694 Published online Mar 16, 2025. doi: 10.4253/wjge.v17.i3.102694
Long-term outcomes of endoscopic submucosal dissection for gastric dysplasia and early neoplasia in a United Kingdom Caucasian population
Sammi X Y Lim, Elizabeth Ratcliffe, Ryan Wiltshire, James G S Whiteway, Stephen McGrath, Javed Sultan, Neeraj Prasad, Arash Assadsangabi, James Britton, Yeng S Ang
Sammi X Y Lim, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Elizabeth Ratcliffe, Ryan Wiltshire, James G S Whiteway, Stephen McGrath, Neeraj Prasad, Arash Assadsangabi, James Britton, Yeng S Ang, Department of Endoscopy and Gastroenterology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
Javed Sultan, Department of Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
Co-first authors: Sammi XY Lim and Elizabeth Ratcliffe.
Author contributions: Lim SXY and Ratcliffe E wrote the manuscript with input from all authors, they contributed equally to this article, they are the co-first authors of this manuscript; Ang YS supervised the project; Lim SXY, Wiltshire R, and Whiteway JGS collected and analyzed the data; Lim SXY, Ratcliffe E, Wiltshire R, Whiteway JGS, McGrath S, Sultan J, Prasad N, Assadsangabi A, Britton J, and Ang YS helped to shape the research, discussed the results and provided critical feedback and comments for the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Institutional Review Board, confirm that the work done and presented in this manuscript is under “audit and service improvement” section of our directorate and as such no research ethical approval is required.
Informed consent statement: This letter is to confirm that the work done and presented in this manuscript is under “audit and service improvement” section of our directorate and as such no research ethical approval is required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yeng S Ang, MD, Professor, Department of Endoscopy and Gastroenterology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom. yeng.ang@nca.nhs.uk
Received: October 28, 2024 Revised: December 23, 2024 Accepted: February 12, 2025 Published online: March 16, 2025 Processing time: 139 Days and 16 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is increasingly used to treat gastric dysplasia and early neoplasia in the West. Unlike Eastern countries, data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.
AIM
To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.
METHODS
Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023. The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence, which include en-bloc and curative resection (CR) rates, local recurrence and survival rates.
RESULTS
ESD was attempted on 111 lesions in 93 patients. 95.0% of completed procedures achieved endoscopic clearance. 74.3% were en-bloc resections and the rest were hybrid ESD with piecemeal resections. In all, 34.7% achieved histological CR. Overall, disease recurrence was 10.9% at latest follow-up (63 months, median follow-up). Importantly 100% of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up. In the Indeterminate and Non-CR group, 18.8% of lesions showed disease recurrence at subsequent endoscopic follow-ups. ESD changed the histological staging of 44.5% of lesions. Immediate complications were observed in 9.9% of all ESD procedures. The median survival time was 69 months post-ESD. The mean age at death is 82.2 years old.
CONCLUSION
The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.
Core Tip: Through our ten-year retrospective analysis, there are clear improvements in the efficacy of gastric endoscopic submucosal dissection measured by en-bloc resection, endoscopic clearance, curative resection and local recurrence rates. Endoscopic submucosal dissection is demonstrated to be a safe and effective tool in treating gastric dysplasia and early neoplasia in the Caucasian population with acceptable rates of immediate and late complications, and survival duration.
