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©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
ARTICLE HIGHLIGHTS
Research background
Endoscopic submucosal dissection (ESD) is a minimally invasive technique used to treat early superficial lesions of the gastrointestinal tract. It is popular in Far East countries where its outstanding efficacy has been proven by multiple studies. Technological advances have recently made ESD more accessible worldwide. In the United Kingdom, this intervention is still relatively new and local evidence to support its use still scarce.
Research motivation
This study aims to evaluate the application of ESD in Caucasian patients in the United Kingdom and seeks to compensate for the lack of evidence in the literature in favour of its use in this country. Larger scale studies will be required in the future.
Research objectives
This study constitutes a step forward in providing the evidence necessary to support the application of ESD among Caucasian patients in the United Kingdom as well as to help produce standardised clinical guidelines to inform local clinical practice for this relatively new intervention.
Research methods
This retrospective study uses data obtained from the Department of Gastroenterology at Salford Royal NHS Foundation Trust in the United Kingdom, a tertiary centre for gastrointestinal interventions. Data for a period of 2 years has been analysed using Microsoft Excel.
Research results
Of the 21 lesions resected with ESD, 6 achieved curative resection (CR), 10 were “indefinite” for CR or non-CR, and 5 were considered non-CR. A favourable long-term outcome was observed in the CR and “indefinite” groups, with clearance of dysplasia observed overall in 81.8% of patients who had had at least one endoscopic follow-up. ESD also changed the histological diagnoses in 66.6% of cases. These results are promising and provide early evidence in favour of the use of ESD in the United Kingdom.
Research conclusions
ESD as applied to Caucasian patients in the United Kingdom can produce promising results as shown by this study. There have not been similar studies in the United Kingdom in the past and thus larger scale studies are required to fully evaluate the efficacy and safety profile of ESD as applied to upper gastrointestinal cancers.
Research perspectives
To better assess the effectiveness of ESD at clearing early neoplastic lesions of the stomach and other upper gastrointestinal cancers among Caucasian patients in the United Kingdom, a prospective study involving a larger sample of such patients is required.
