Real-life evaluation of the safety, efficacy and therapeutic outcomes of endoscopic submucosal dissection in a Western tertiary centre

Background: Endoscopic submucosal dissection (ESD) enables accurate pathological evaluation and low recurrence rates. Large series describing ESD outcomes in Western countries are scarce. Objective: To evaluate the real-life experience of ESD in a single Western centre. Methods: Data of all the patients submitted to ESD in our centre were prospectively recorded in a database, from the first procedure in 2011 until May 2017. Feasibility, en bloc and R0 resection rates and safety were assessed. Results: Three hundred and one ESDs were performed (37 in submucosal lesions) on 283 patients (54% male). Lesions were located in the oesophagus (n = 13), stomach (n = 169), duodenum (n = 4), colon (n = 35) and rectum (n = 80). ESD was technically successful in 292 lesions (97%); among malignant or premalignant epithelial lesions (n = 232), the en bloc resection rate was 91% and, of those, the R0 resection rate was 87% (between 69% in the colon and 93% in the stomach). Two patients needed surgery due to adverse events. Surgery for non-curative ESD was performed in 12 cases (58% without residual lesion). There were 10 perforations, 9 of them closed endoscopically. Mortality was 0%. Conclusion: Our real-life experience shows that ESD is feasible, safe and effective in Western settings.