Gastroenterology and Endoscopy Departiment, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy.
Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy.
Eur J Gastroenterol Hepatol. 2024 Nov 1;36(11):1281-1287. doi: 10.1097/MEG.0000000000002829. Epub 2024 Jul 15.
Endoscopic submucosal dissection (ESD) is a minimally invasive technique for the resection of superficial gastrointestinal lesions, providing high rates of 'en bloc' and R0 resection. East-West differences in ESD quality indicators have been reported. This study aims to assess feasibility, effectiveness, and safety of ESD for the treatment of superficial gastrointestinal (GI) lesions in a Western cohort.
Consecutive patients undergoing ESD at one Italian endoscopic referral center from September 2018 to March 2020 were included in this prospective study. Primary outcomes were technical success, R0 resection rate, curative resection rate, and adverse events (AEs).
In total 111 patients (111 lesions) undergoing ESD were included. Anatomic site of the lesions was rectum in 56.8%, colon in 13.5%, stomach in 24.3%, and esophagus in 5.4% of cases, respectively. For upper GI procedures, technical success was 100%, and R0 and curative resection rates were 84.8% and 78.8%, respectively. For colorectal procedures, technical success was 98.7%, R0 and curative resection rates were 88.5% and 84.6%, respectively. Major AEs were reported in 12 cases (10.8%).
The introduction of ESD in a Tertiary Center is feasible, effective, and safe, and should be taken into consideration for the treatment of superficial GI lesions requiring 'en bloc' resection.
内镜黏膜下剥离术（ESD）是一种微创技术，用于切除胃肠道浅层病变，可实现较高的整块切除（en bloc）和 R0 切除率。已有研究报道了东西方在 ESD 质量指标方面的差异。本研究旨在评估 ESD 治疗西方人群胃肠道浅层病变的可行性、有效性和安全性。
本前瞻性研究纳入了 2018 年 9 月至 2020 年 3 月期间在意大利一家内镜转诊中心接受 ESD 的连续患者。主要结局为技术成功率、R0 切除率、治愈性切除率和不良事件（AEs）。
共纳入 111 例（111 处病变）接受 ESD 的患者。病变的解剖部位分别为直肠 56.8%、结肠 13.5%、胃 24.3%和食管 5.4%。上胃肠道手术的技术成功率为 100%，R0 和治愈性切除率分别为 84.8%和 78.8%。结直肠手术的技术成功率为 98.7%，R0 和治愈性切除率分别为 88.5%和 84.6%。12 例（10.8%）患者发生了主要不良事件。
在三级中心引入 ESD 是可行、有效且安全的，对于需要整块切除的胃肠道浅层病变的治疗应予以考虑。
