Introduction

The outcome of ESD in early gastrointestinal neoplasia in Japan is well established. However, in the west, ESD practice is variable given different disease prevalence in UGI tract and also the volume and experience of each centre.

Aims & Methods

We aim to evaluate ESD practice and outcomes in the UK and hence, multi centre registry was set up. This is a prospective observational study for patients undergoing ESD for early GI neoplasia. All technical and outcomes data was prospectively collected onto REDCap.

Results

There were 451 UGI ESD cases recruited between August 2016 to August 2023 from 6 large tertiary referral centres in the UK. Mean age of the patients was 70.8 years (range: 24-94 years) with male preponderance (318 males vs. 133 females). Majority were in oesophagus: 282 (62.53%), stomach: 159 (35.25%) and duodenum: 10 (2.22%).
Of 282 oesophageal ESDs, 277 (98.23%) were technically successful with en-bloc resection rate of 96%. There were 3 intraprocedural complications (2 oesophageal perforations and 1 oral laceration from overtube). All of them were managed endoscopically. There were 29 (10.28%) post ESD strictures requiring endoscopic dilatations. 3 (1.06%) delayed bleeding were noted and 3 were readmitted for decompensation of underlying co-morbidities.
There were 204/282 (72.34%) Barrett’s cases with average length of C3 M5 and mean size 34.5mm. 34 cases (16.67%) had previous ESD or ablation at the same site. Post ESD resection showed deep submucosal (SM) invasion in 21 patients (deep R0 achieved in 42.9% and lateral R0 in 76.2%), 23 pT1bSM1 (deep R0 in 87.0% and lateral R0 in 87%), 107 pT1a (deep R0 in 89.7% and lateral R0 in 85.1%), 31 high grade dysplasia (HGD) (R0 in 97%) and 9 low grade dysplasia (LGD) (R0 in 78%) as shown in Table 1.
There were 44 squamous cell carcinoma (SCC), 26 gastro-oesophageal junctional neoplasia and 8 others (submucosal lesion and granular cell tumours). Of 44 SCC, there were 8 pT1b (5 achieved deep R0, 7 achieved lateral R0), 10 pT1a (all achieved both deep and lateral R0), 22 HGD (81.8% achieved R0), 3 LGD (all achieved R0) as shown in Table 1.
There were 160 gastric ESDs with completion rate of 96.25% and en-bloc rate of 95.5%. There were 8 (5%) intra-procedural perforation which required endoscopic clippings. There were 7 (4.36%) delayed bleeds which were managed endoscopically. Of 160 cases, 138 were epithelial neoplasia, 11 were submucosal lesions while 4 were large hyperplastic polyps. As shown in Table 1, of 138 epithelial neoplasia, 10 had deep SM invasion (7 achieved deep R0, 8 lateral R0), 14 pT1bSM1 (7 achieved deep R0, 10 lateral R0), 50 pT1a (90% achieved deep R0, 80% lateral R0), 35 HGD (94.3% R0) and 27 LGD (77.8% R0).

Conclusion

Unlike in the East, most ESDs in our study were performed in Barrett’s oesophagus rather than the stomach. Our data demonstrates the feasibility and safety of UGI ESD in Western setting with high en-bloc rate and low complication rates. We found that within indication of ESD, complete resection (R0) rate is high but lesions with deep submucosal invasion have poor R0 rate.

Disclosure

Professor Bhandari has received research grants or is the advisory board for Fujifilm, Boston, Olympus, Pentax, 3-D matrix, NEC (Japan), Medtronic.