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PREDICTIVE FACTORS FOR NON CURATIVE RESECTION FOLLOWING GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION

Ana Clara Vasconcelos 1, Nuno Gonçalves 1, Ângela Domingues 2, Catarina Lopes Brandão 3, Pedro Pimentel-Nunes 4, Mario Dinis-Ribeiro 5, Diogo Libânio 5

Affiliations

1 Portuguese Oncology Institute of Porto, Porto, Portugal

2 Unidade Local de Saúde de Viseu Dão-Lafões, E.P.E., Viseu, Portugal

3 RISE@CI-IPO (Health Research Network), Porto, Portugal|||Portuguese Oncology Institute of Porto, Porto, Portugal

4 RISE@CI-IPO (Health Research Network), Porto, Portugal

5 Portuguese Oncology Institute of Porto, Porto, Portugal|||RISE@CI-IPO (Health Research Network), Porto, Portugal

Summary

AI Generated

A retrospective cohort study of 974 gastric endoscopic submucosal dissections identified six independent predictors of non-curative resection, which occurred in 11.9% of cases.

Among 974 gastric epithelial lesions treated by ESD between 2005 and 2024, non-curative resection occurred in 116 cases (11.9%), with en bloc resection achieved in 96.9% and R0 resection in 92.5%.
Six independent predictive factors for non-curative resection were identified: location in the superior third of the stomach (adjusted OR 2.275), lesion size greater than 20mm (aOR 4.212), depressed or ulcerated morphology (aOR 2.394), sessile or pedunculated morphology (aOR 4.186), high-grade dysplasia on prior biopsy (aOR 4.372), and carcinoma on prior biopsy (aOR 12.484).
Non-curative resection was defined using high-risk resection criteria from European Society of Gastrointestinal Endoscopy guidelines, and the study excluded incomplete ESD procedures.
The authors conclude that lesion location, size, morphology, and previous biopsy results may assist in decision-making regarding treatment allocation for gastric superficial lesions.

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Abstract

Introduction

Endoscopic submucosal dissection (ESD) is the technique of choice for treating early gastric cancer deemed to have very low risk of lymph node metastasis based on endoscopic evaluation. However, currently, up to 20% of ressected lesions do not meet curative criteria, underlining the importance of patient selection.

Aims & Methods

We aimed to evaluate predictive factors for non curative ressection. We conducted a retrospective cohort study including consecutive gastric epithelial lesions removed by ESD between January of 2005 and June of 2024. Incomplete ESD were excluded. Non curative resection was defined using the high-risk resection criteria from the European Society of Gastrointestinal Endoscopy guidelines. Univariate and multivariate analysis were used to identify predictive factors.

Results

From 990 ESD, 974 were included in the final analysis: median size of lesion 19mm (P25-P75: 15-25), presence of ulceration in 25 (2.8%), deep submucosal invasion in 74 (7.6%), en bloc resection in 944 (96.9%), R0 resection in 901 (92.5%) and non curative resection in 116 (11.9%). In this sample, the following independent predictive factors for non curative resection were identified: location on the superior third of the stomach [adjusted Odds Ratio (aOR) 2.275; IC95% 1.248-4.148], lesion size > 20mm (aOR 4.212; IC95% 2.618-6.775), depressed/ulcerated lesion (aOR 2.394; IC95% 1.328-4.315) or sessile/pedunculated lesion (aOR 4.186; IC95% 2.083-8.411), presence of high-grade dysplasia (aOR 4.372; IC95% 2.139-8.939) or carcinoma (aOR 12.484; IC95% 5.995-25.998) in previous biopsies.

Conclusion

Location, size and morphology of lesion, as well as previous biopsy results are predictive factors for non curative resection, and may assist in decision-making regarding treatment alocation of gastric superficial lesions.

References

Dinis-Ribeiro M, et al. Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025. Endoscopy, 2025 May;57(5):504-554. doi: 10.1055/a-2529-5025.
Vasconcelos AC, et al. Endoscopic Resection of Early Gastric Cancer and Pre-malignant Gastric Lesions. Cancers, 2023 Jun 7;15(12):3084. doi: 10.3390/cancers15123084.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

ESD in the upper GI tract (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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