Details

Autor(en) / Beteiligte

• Tsujii, Yoshiki
• Nishida, Tsutomu
• Nishiyama, Osamu
• Yamamoto, Katsumi
• Kawai, Naoki
• Yamaguchi, Shinjiro
• Yamada, Takuya
• Yoshio, Toshiyuki
• Kitamura, Shinji
• Nakamura, Takeshi
• Nishihara, Akihiro
• Ogiyama, Hideharu
• Nakahara, Masanori
• Komori, Masato
• Kato, Motohiko
• Hayashi, Yoshito
• Shinzaki, Shinichiro
• Iijima, Hideki
• Michida, Tomoki
• Tsujii, Masahiko
• Takehara, Tetsuo

Titel

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study

Ist Teil von

• Endoscopy, 2015-09, Vol.47 (9), p.775-783

Ort / Verlag

Germany

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals. Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed. The median tumor size was 18 mm (range 2 - 85 mm). The median procedure time was 90 minutes (range 12 - 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % - 98.1 %) and 84.5 % (95 %CI 80.5 % - 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % - 7.9 %), 1.6 % (95 %CI 0.7 % - 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % - 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 - 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections. Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.