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Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis

Endoscopic submucosal dissection (ESD) has become the standard treatment for early malignant lesions in the upper gastrointestinal (GI) tract. Its clinical results have been reported to be as good as surgery. The outcomes of rescue surgery after non-curative ESD have been reported to be as good as f...

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Autores principales: Pimingstorfer, Philipp, Biebl, Matthias, Gregus, Matus, Kurz, Franz, Schoefl, Rainer, Shamiyeh, Andreas, Spaun, Georg O., Ziachehabi, Alexander, Fuegger, Reinhold
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647895/
https://www.ncbi.nlm.nih.gov/pubmed/37959405
http://dx.doi.org/10.3390/jcm12216940
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author Pimingstorfer, Philipp
Biebl, Matthias
Gregus, Matus
Kurz, Franz
Schoefl, Rainer
Shamiyeh, Andreas
Spaun, Georg O.
Ziachehabi, Alexander
Fuegger, Reinhold
author_facet Pimingstorfer, Philipp
Biebl, Matthias
Gregus, Matus
Kurz, Franz
Schoefl, Rainer
Shamiyeh, Andreas
Spaun, Georg O.
Ziachehabi, Alexander
Fuegger, Reinhold
author_sort Pimingstorfer, Philipp
collection PubMed
description Endoscopic submucosal dissection (ESD) has become the standard treatment for early malignant lesions in the upper gastrointestinal (GI) tract. Its clinical results have been reported to be as good as surgery. The outcomes of rescue surgery after non-curative ESD have been reported to be as good as first-line surgery. The aim of this study was to evaluate the outcomes of ESD in the upper GI tract and the outcomes of rescue surgery after non-curative ESD performed in Linz, Austria, between 2009 and January 2023. A total of 193 ESDs were included and divided into 104 esophageal ESD and 89 gastric ESD procedures. The criteria for curative ESD were in line with established guidelines’ recommendations. For esophageal lesions, the mean lesion size was 40.3 mm and the rate of curative ESD was 56.7%. In the non-curative ESD, the rate of technical failure as the reason for non-curative ESD was 13.3% and the oncological failure rate was 86.7%. Only 48.7% of indicated rescue surgeries were performed. The main reason for not performing surgery was interdisciplinary consensus due to comorbidity. Perioperative complications Dindo–Clavien ≥ 3 occurred in 22.2% of cases with an in-hospital mortality rate of 0. In gastric lesions, the mean size was 39 mm and the rate of curative ESD was 69.7%. The rate of technical failure as a reason for non-curative ESD was 25.9% and the oncological failure rate was 74.1% for non-curative ESD. Rescue surgery was performed in 48.2% of indicated cases. The perioperative rate for major complications was 0. The outcome of ESD in the upper GI tract is in line with the published literature, and non-curative ESD does not worsen surgical outcomes. The available follow-up data are in line with the international published literature, showing a low rate of residual malignancy in surgical resection specimens. Therefore, the indication of rescue surgery for oncological failure remains challenging. Furthermore, the learning curve of ESD has shown a trend towards improving outcomes over time.
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spelling pubmed-106478952023-11-06 Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis Pimingstorfer, Philipp Biebl, Matthias Gregus, Matus Kurz, Franz Schoefl, Rainer Shamiyeh, Andreas Spaun, Georg O. Ziachehabi, Alexander Fuegger, Reinhold J Clin Med Article Endoscopic submucosal dissection (ESD) has become the standard treatment for early malignant lesions in the upper gastrointestinal (GI) tract. Its clinical results have been reported to be as good as surgery. The outcomes of rescue surgery after non-curative ESD have been reported to be as good as first-line surgery. The aim of this study was to evaluate the outcomes of ESD in the upper GI tract and the outcomes of rescue surgery after non-curative ESD performed in Linz, Austria, between 2009 and January 2023. A total of 193 ESDs were included and divided into 104 esophageal ESD and 89 gastric ESD procedures. The criteria for curative ESD were in line with established guidelines’ recommendations. For esophageal lesions, the mean lesion size was 40.3 mm and the rate of curative ESD was 56.7%. In the non-curative ESD, the rate of technical failure as the reason for non-curative ESD was 13.3% and the oncological failure rate was 86.7%. Only 48.7% of indicated rescue surgeries were performed. The main reason for not performing surgery was interdisciplinary consensus due to comorbidity. Perioperative complications Dindo–Clavien ≥ 3 occurred in 22.2% of cases with an in-hospital mortality rate of 0. In gastric lesions, the mean size was 39 mm and the rate of curative ESD was 69.7%. The rate of technical failure as a reason for non-curative ESD was 25.9% and the oncological failure rate was 74.1% for non-curative ESD. Rescue surgery was performed in 48.2% of indicated cases. The perioperative rate for major complications was 0. The outcome of ESD in the upper GI tract is in line with the published literature, and non-curative ESD does not worsen surgical outcomes. The available follow-up data are in line with the international published literature, showing a low rate of residual malignancy in surgical resection specimens. Therefore, the indication of rescue surgery for oncological failure remains challenging. Furthermore, the learning curve of ESD has shown a trend towards improving outcomes over time. MDPI 2023-11-06 /pmc/articles/PMC10647895/ /pubmed/37959405 http://dx.doi.org/10.3390/jcm12216940 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pimingstorfer, Philipp
Biebl, Matthias
Gregus, Matus
Kurz, Franz
Schoefl, Rainer
Shamiyeh, Andreas
Spaun, Georg O.
Ziachehabi, Alexander
Fuegger, Reinhold
Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title_full Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title_fullStr Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title_full_unstemmed Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title_short Endoscopic Submucosal Dissection in the Upper Gastrointestinal Tract and the Need for Rescue Surgery—A Multicenter Analysis
title_sort endoscopic submucosal dissection in the upper gastrointestinal tract and the need for rescue surgery—a multicenter analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647895/
https://www.ncbi.nlm.nih.gov/pubmed/37959405
http://dx.doi.org/10.3390/jcm12216940
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