Endoscopic submucosal dissection for gastric lesions: results of an European inquiry

Background and study aims: In Japanese centers, endoscopic submucosal dissection (ESD) is commonly used for the resection of early gastric lesions. However, in Europe, only a few reports have been published. The aim of the current study was to survey the current use of ESD by European endoscopists. Methods: Between April and May 2009, European endoscopists (n = 490) who had articles published in the journals Endoscopy and/or Gastrointestinal Endoscopy during 2007 and 2008 were asked to complete an online questionnaire. Results: A total of 58 endoscopists completed the questionnaire (12 %). Only 20 centers performed ESD, which was mostly performed by a single endoscopist in each center. Each endoscopist had treated a mean of four cases during the previous year (mean total experience 11 ESDs) bringing a total of 510 ESDs across all European centers that responded (197 during the past year). Lesions were located in the antrum in 35% of cases; 39% were Paris classification IIa, 22% IIa+b, and 18% IIa+c. Overall, the average of mean lesion diameter was 15.7mm (range 1-70.0 mm). Most cases were non-invasive high-grade intraepithelial neoplasia (44 %) or adenocarcinoma (36 %). An insulated-tipped knife (1 or 2) was used in 70% of procedures and an average of the mean duration of procedures was 108 minutes. In all, 78% of lesions were removed en bloc with an R0 rate of 77%. Endoscopists experienced major complications (perforation or major bleeding) in 13% of cases. Conclusion: ESD in Europe seems to be performed at a few centers, with most endoscopists performing a low number of procedures, achieving a high rate of efficacy and a moderate rate of major complications. However, as a potential selection bias may have occurred, multicenter registries should be conducted to help address the problem of dissemination of this technique.