Long-term outcomes of endoscopic submucosal dissection for gastric dysplasia and early neoplasia in a United Kingdom Caucasian population

Table 1 Patient demographics and features of gastric lesions with endoscopic submucosal dissection attempted, n (%)

Variable	Value
Patient demographics	n = 93
Age at time of ESD procedure (years), mean ± SD (range)	75 ± 9.01 (41-91)
Male/female	59/34
Caucasian	93 (100)
Average number of ESD attempts per patient	1.20
Features of lesions with ESD attempted	n = 111
Diameter of lesions (mm), mean ± SD (range)	30.4 ± 14.7 (10-100)
Location of lesions
Lower	65 (58.6)
Middle	32 (28.8)
Upper	14 (12.6)
Paris classification
1p	1
1s	9
1s + 1sp	1
1sp	18
1s + 2a	1
1s + 2b	1
1sp + 2c	1
2a	28
2a + 2b	4
2a + 2c	44
2b	2
2b + 2c	1
Pre-index histology
No dysplasia	0 (0)
Indefinite for dysplasia	2 (1.8)
Low grade dysplasia	43 (38.7)
High grade dysplasia	41 (36.9)
Intramucosal carcinoma	25 (22.5)
Adenocarcinoma with submucosal invasion	0 (0)

ESD: Endoscopic submucosal dissection.

Table 2 Results of completed gastric endoscopic submucosal dissection procedures

Results of completed ESD procedures	Value, n = 101
Average length of hospital stay (day/s), mean ± SD (range)	1.60 ± 3.10 (0-30)
Number of 8-day readmission(s)	1
ESD technique
ESD	61
Hybrid ESD	40
Resection
En-bloc	75
Piecemeal	26
Margins clear on endoscopy, n (%)	96 (95.0)
Margins not clear on endoscopy, n (%)	5 (4.95)
Curative resection	35
Non-curative resection	34
For gastric dysplasia
HM not clear, VM clear	15
HM clear, VM not clear	0
Both HM and VM not clear	1
For early gastric neoplasia
Clear margins for cancer and dysplasia but submucosal invasion	5
Clear margins for cancer, but HM and/or VM not clear for dysplasia	2
Clear margins for cancer, but indeterminate for dysplasia	3
HM and/or VM not clear for cancer	7
Indeterminate margins for cancer and dysplasia	1
Indeterminate	29
End piece(s) affected by dysplasia, unable to confirm excision of dysplasia at HM	15
Poor tissue preservation	4
Piecemeal resections	8
Piecemeal and end pieces affected by dysplasia	2
Not assessable - index histology shows no dysplasia or indefinite for dysplasia	3

ESD: Endoscopic submucosal dissection; HM: Horizontal margin; VM: Vertical margin.

Table 3 Five-yearly comparisons of completed gastric endoscopic submucosal dissection outcomes, n (%)

Variable	2012-2017	2018-2023
Total number of lesions with completed ESD	33	68
Resection
En-bloc	19 (57.6)	56 (82.4)
Piecemeal	14 (42.4)	12 (17.6)
Margins clear on endoscopy	29 (87.9)	67 (98.5)
Margins not clear on endoscopy	4 (12.1)	1 (1.47)
CR group
Total number of lesions in CR group	6 (18.2)	29 (42.6)
Number of lesions not under follow-up	0	3
Number of lesions with no residual disease or recurrence	6 (100)	26 (100)
Indeterminate group
Total number of lesions in Indeterminate group	14 (42.4)	15 (22.1)
Number of lesions not under follow-up	2	4
Number of lesions with no residual disease or recurrence	5 (41.7)	6 (54.5)
Non-CR group
Total number of lesions in non-CR group	11 (33.3)	23 (33.8)
Number of pT1b lesions	4	10
Number of lesions not under follow-up	0	7
Number of lesions resected surgically	1	5
Number of lesions with no residual disease or recurrence	6 (54.5)	8 (50.0)
Not assessable
Number of lesions with index histology showing no dysplasia or indefinite for dysplasia	2	1

ESD: Endoscopic submucosal dissection; CR: Curative resection.

Table 4 Disease recurrence on subsequent follow-ups

Recurrence of lesions after completed ESD procedures over 10 years	Value, n = 101
CR group
Total number of lesions in CR group	35
Number of lesions under follow-up	32
Number of lesions with no residual disease or recurrence at all follow-ups, n (%)	32 (100)
Indeterminate group
Total number of lesions in indeterminate group	29
Number of lesions under follow-up	23
Number of lesions with no residual disease or recurrence, n (%)	11 (47.8)
Residual disease	5
Local recurrence	2
Metachronous	5
Synchronous	0
Number of lesions showing no recurrence at latest follow-up, n (%)	16 (69.6)
Number of lesions showing disease recurrence at latest follow-up (%)	7 (30.4)
Non-CR group
Total number of lesions in non-CR group	34
Number of lesions under follow-up	21
Number of lesions with no residual disease or recurrence, n (%)	14 (66.7)
Residual disease	2
Local recurrence	3
Metachronous	1
Synchronous	1
Number of lesions showing no recurrence at latest follow-up, n (%)	17 (81.0)
Number of lesions showing disease recurrence at latest follow-up, n (%)	4 (19.0)
Not Assessable - total number of lesions with index histology showing no dysplasia or indefinite for dysplasia	3

ESD: Endoscopic submucosal dissection; CR: Curative resection.