Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal

Background and study aims: Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal. Patients and methods: This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n=54) or ESD (n=141) and were followed up for a median of 3.2 years. Results: Resection was feasible in 97%, with en bloc and R0 resection rates of 85% (94% ESD vs. 61% EMR; P=0.001) and 81% (91% ESD vs. 54% EMR; P<0.001), respectively. The recurrence rate was 7%, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95% confidence interval 3.9-8.8). The long-term curative resection rate was 86% after one procedure and 91% after two procedures. Adverse events were observed in 13% of cases: 8% bleeding and 2% of perforations (EMR=ESD). Surgery was performed in 7%: 6% after noncurative endoscopic resection and 1% due to complications. Metachronous lesion detection rate was 1%-1.5% per patient year. Cancer-specific survival rate was 100% at follow-up. Conclusions: For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries.