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• W2978669354 abstract "Purpose: Endoscopic submucosal dissection (ESD) enables en bloc resection and is associated with high success rates for early neoplastic lesions in the gastrointestinal (GI) tract. Compared with the piecemeal resection associated with endoscopic mucosal resection, ESD allows for more accurate histological assessments for adequacy of complete resection and has reduced overall recurrence rates. ESD is not widely performed in Western countries given increased technical difficulty, high complication rates, availability of tools, and long procedure times. Here we present a case series of all ESDs performed at a single center in the United States. Methods: A retrospective chart review was performed to identify all cases in which a single operator (IW) performed ESD at a tertiary care referral center. A total of 15 cases were identified, six performed in the upper GI tract (four esophagus and two stomach) and nine in the lower GI tract (eight rectal and one sigmoid colon). Data regarding location of lesion, pathology, method of ESD (composition and volume of lifting injection and method of resection), post-procedure complications, and involvement of margins on resected specimen were collected. Results: A variety of devices were utilized to perform ESD: hook knife (3), needle knife (2), flexible-tip knife (7), insulated tip knife (1), or a combination (2). Major complications occurred in 1/15 (6.6%), which was a perforation. Minor blood loss was reported in two procedures (13%), both of which were endoscopically treated with coagulation and/or placement of hemostatic clips. ESD was successfully performed in 12/15 (80%) of cases, with exceptions secondary to perforation (1) and inability to dissect the submucosal layer (2). Of the 12 procedures in which pathology was obtained by ESD, 11/12 (92%) had clear margins. Conclusion: Our major complication (6.6%) and complete resection rates (92%) were similar to those found in large Japanese studies on ESD performed by Myanoto and Tamegi et al. Our case series show that ESD can safely and effectively be performed in a Western setting. ESD will gain more traction in Western countries with continued improvement in early detection of gastrointestinal neoplasms, increased clinical experience, development of specialized training programs, and refinement of instruments." @default.
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• W2978669354 date "2013-10-01" @default.
• W2978669354 modified "2023-10-17" @default.
• W2978669354 title "A Single Center Case Series of Endoscopic Submucosal Dissection Performed in a Western Setting" @default.
• W2978669354 doi "https://doi.org/10.14309/00000434-201310001-01965" @default.
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