Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2017; 9(12): 561-570
Published online Dec 16, 2017. doi: 10.4253/wjge.v9.i12.561
Gastric endoscopic submucosal dissection as a treatment for early neoplasia and for accurate staging of early cancers in a United Kingdom Caucasian population
Aisha Sooltangos, Matthew Davenport, Stephen McGrath, Jonathan Vickers, Siba Senapati, Kurshid Akhtar, Regi George, Yeng Ang
Aisha Sooltangos, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
Aisha Sooltangos, Matthew Davenport, Regi George, Yeng Ang, Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
Stephen McGrath, Department of Pathology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
Jonathan Vickers, Siba Senapati, Kurshid Akhtar, Department of Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
Regi George, Department of Gastroenterology, Pennine Acute NHS Trust, Rochdale Old Rd, Bury BL9 7TD, United Kingdom
Yeng Ang, Gastrointestinal Science, University of Manchester, Manchester M13 9PL, United Kingdom
Author contributions: Ang Y designed the study, supervised the project, obtained the data and wrote the manuscript; Sooltangos A coordinated the study, obtained and analysed the data, and wrote the manuscript; McGrath S reviewed all pathology reports and contributed to data analysis; George R and Ang Y performed the ESD and analysed the data; Vickers J, Senapati S and Akhtar K performed surgery and analysed the data.
Informed consent statement: All the data used in this study have been anonymised.
Conflict-of-interest statement: None to declare.
Data sharing statement: All data are under the control of the gastroenterology team at Salford Royal NHS Foundation Trust.
Open-Access: 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/
Correspondence to: Yeng Ang, MD, Doctor, Full Professor, Department of Gastroenterology, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom. yeng.ang@srft.nhs.uk
Telephone: +44-0161-2065798 Fax: +44-0161-2065798
Received: September 7, 2017
Peer-review started: September 8, 2017
First decision: September 26, 2017
Revised: October 18, 2017
Accepted: November 15, 2017
Article in press: November 15, 2017
Published online: December 16, 2017
Abstract
AIM

To investigate the efficacy of endoscopic submucosal dissection (ESD) at diagnosing and treating superficial neoplastic lesions of the stomach in a United Kingdom Caucasian population.

METHODS

Data of patients treated with or considered for ESD at a tertiary referral center in the United Kingdom were retrieved for a period of 2 years (May 2015 to June 2017) from the electronic patient records of the hospital. Only Caucasian patients were included. Primary outcomes were curative resection (CR) and were defined as ESD resections with clear horizontal and vertical margin and an absence of lympho-vascular invasion, poor differentiation and submucosal involvement on histological evaluation of the resected specimen. Secondary end-points were reversal of dysplasia at 12 mo endoscopic follow-up and/or at the latest follow up. Change in histological diagnosis pre and post ESD was also analysed.

RESULTS

Twenty-four patients were initially identified with intention to treat. 19 patients were eligible after mapping gastroscopy and ESD was attempted on a total of 25 ESD lesions, 4 of which failed and had to be aborted mid-procedure. Out of 21 ESD performed, en-bloc resection was achieved in 71.4% of cases. Resection was considered complete on endoscopy in 90.5% of cases compared to only 38.1% on histology. A total of 6 resections were considered curative (28%), 5 non-curative (24%) and 10 indefinite for CR or non-CR (24%). ESD changed the histological diagnosis in 66.6% of cases post ESD. Endoscopic follow-up in the “indefinite” group and CR group showed that 50% and 80% of patients were clear of dysplasia at the latest follow-up respectively; 2 cases of recurrence were observed in the “indefinite”group. Survival rate for the entire cohort was 91.7%.

CONCLUSION

This study provides early evidence for the efficacy of ESD as a therapeutic and diagnostic intervention in Caucasian populations and supports its application in the United Kingdom.

Keywords: Endoscopic resection, Endoscopic submucosal dissection, Endoscopic mucosal resection, Dysplasia, Early gastric cancer, United Kingdom

Core tip: Endoscopic submucosal dissection (ESD) is a minimally invasive technique used to diagnose or treat early neoplastic lesions of the gastrointestinal tract. Imported from Far East countries, where it is extensively used, this intervention has proven to be highly effective in carefully selected patients and to constitute a viable alternative to radical surgery. ESD is relatively new in the West and local evidence to support its use in the United Kingdom lacking. This retrospective study provides early evidence in favour of the use of ESD in the United Kingdom.