Gastric endoscopic submucosal dissection as a treatment for early neoplasia and for accurate staging of early cancers in a United Kingdom Caucasian population

Table 1 Demographic data of patients included in the study n (%)

Variable	Value, n = 24
Number of patients assessed for ESD, n	24
Age, Mean ± SD, yr	73.0 ± 10.7
Age, range, yr	44-86
Gender, male	20 (83.3)
Gender, female	4 (16.7)
Caucasian ethnicity	24 (100)

ESD: Endoscopic submucosal dissection.

Table 2 Features found to make endoscopic submucosal dissection unsuitable in 5 patients

Patient	Reasons
A	Ulcerated lesion
B	SM3 or deeper invasion; Poorly differentiated lesion
C	Large size: 4-5 cm; Ulcerated over 3 cm
D	Severe oesophageal stricture prevented passage of scope
E	KATO 3; Deeply ulcerated; Poorly differentiated

Table 3 Features of lesions on which endoscopic submucosal dissection has been attempted n (%)

Variable	Value, n = 25
Location of lesion
Upper stomach	4 (16)
Mid stomach	7 (28)
Lower stomach	14 (56)
Average of longer axis of lesion (mm)
Mean ± SD	24.7 ± 11.7
Range	10-50
Histological grade at baseline
IMC	13 (52)
HGD	8 (32)
LGD	3 (12)
Invasive	1 (4)

LGD: Low grade dysplasia; HGD: High grade dysplasia; IMC: Intramucosal carcinoma.

Table 4 Results of endoscopic submucosal dissection n (%)

Variable	Value, n = 21
Average number of ESD per patient (including failed ESD)	1.3
Number of en-bloc resections	15 (71.4)
Number of pieces in which lesions were resected
Mean ± SD	1.5 ± 1.4
Range	1-7
Unspecified but > 1	2
Rate of complete resection on endoscopy	19 (90.5)
Rate of complete resection on histology	8 (38.1)
Margins clear on histology of ESD specimen
Both VM and HM	8 (38.1)
VM only	1 (4.8)
HM only	1 (4.8)
Neither VM nor HM	1 (4.8)
Not specified or difficult to interpret specimen due to coagulation effect/poor preservation of tissue	10 (47.6)

ESD: Endoscopic submucosal dissection.

Table 5 Histological grade of 5 non- curative resection

Patient	Histological grade at baseline	Histopathologic diagnosis on ESD specimen of non-CR
A	IMC	IMC with lympho-vascular invasion
A	IMC	Invasive adenocarcinoma; Lympho-vascular invasion
B	IMC	Invasive adenocarcinoma; Poorly differentiated; Diffuse (signet ring) type; Tumour extends into submucosa; Further de-differentiation noted at the invasive aspect
C	Highly suspicious of IMC	Adenocarcinoma with deep margin involvement; Moderately to poorly differentiation; Vascular invasion
D	Invasive adenocarcinoma	Invasive adenocarcinoma; Well differentiated; No lympho-vascular invasion

ESD: Endoscopic submucosal dissection; CR: Curative resection; IMC: Intramucosal carcinoma.

Table 6 Secondary outcome in the cohort‘ indefinite for curative resection or non- curative resection

Variable	Indefinite, n = 10	CR, n = 5
Number of patients under endoscopic follow-up, n (%)	9 (90)	5 (100)
Median follow-up, mo	2	3
Mean follow-up, mo	5.1	8.5
Range, mo	0-19	0-22
Length of time since ESD, mean ± SD, mo	13.3 ± 11.3	12.2 ± 11.1
Length of time since ESD, range, mo	2 - 38	0 - 26
Number of patients with metachronous or synchronous disease post ESD, n	2	0

ESD: Endoscopic submucosal dissection; CR: Curative resection.