Endoscopic sub-mucosal dissection for early gastric cancer—the Australian experience
Cancer Institute NSW
Gastric cancer is a common cause of mortality worldwide. High prevalence in Asian countries has resulted in screening programs, early detection and endoscopic treatment by endoscopic submucosal dissection (ESD).
Endoscopic sub-mucosal dissection for early gastric cancer
The Australian experience
Authors
Amir Klein, Nicholas tutticci, Farzan Bahin, Eric Lee, Michael J BourkeWestmead hospital and the university of Sydney
Background
Large Japanese and Korean data for ESD of Early Gastric Cancer (EGC) shows high en-bloc and R0 resection rates, low rates of complications and > 95% disease free survival at 5 years without the need for surgery. Western experience with ESD is limited and Australian data is completely absent. With a large Asian immigrant population, increased awareness, widespread screening endoscopy and high quality endoscopic imaging, EGC detection in Australia is likely to increase in the coming years.
Aims
We aim to describe the Australian experience with ESD for EGC in a single tertiary care centre.
Method
Analysis of prospectively collected data (NCT02306707). Data collection included patient, lesion and procedural data and outcomes.
Results
Over 60 months to May 2015 67 patients with EGCs (mean age 73, 73% male) were treated by ESD at Westmead hospital. Lesions underwent careful pre-resection evaluation by high definition white light endoscopy, magnifying chromo-endoscopy and endoscopic ultrasound. Median lesion size was 20 mm (IQR 15-35). Lesions were predominantly flat laterally spreading and most (75%) were located in the distal body/antrum. Complete resection was achieved in 98% at the index procedure (91% en-bloc). Perforation occurred in 1 case and was successfully managed endoscopically with clips. Delayed bleeding occurred in 4 (6%) patients. Complete pathological resection (R0) was achieved in 72% (85% for non invasive lesions). Four patients were referred for surgery due to invasive disease or incomplete resection. Recurrence was encountered and treated endoscopically in one patient on second surveillance endoscopy (median follow-up duration 5.75 months, (IQR 4-10)). For patients without invasive disease, who completed ³1 surveillance endoscopy (n=32), 96.8% were free of disease and considered cured.
Implications
ESD in an Australian tertiary care centre is feasible, safe and effective for the treatment of EGC. Careful assessment, planning and experience with advanced endoscopic resection techniques is mandatory to achieve satisfactory results.