Enrique Rodríguez de Santiago , Alberto Herreros-de-Tejada , Eduardo Albéniz , Felipe Ramos Zabala , Gloria Fernández-Esparrach , Oscar Nogales , Pedro Rosón , Beatriz Peñas García , Hugo Uchima , Álvaro Terán , Joaquín Rodríguez Sánchez , Diego de Frutos , Sofía Parejo Carbonell , José Santiago , José Díaz Tasende , Charly Guarner Argente , Pedro de María Pallarés , Ana Amorós , Daniel Barranco , Daniel Álvarez de Castro , José Carlos Marín-Gabriel
{"title":"在西班牙实施食管内镜黏膜下剥离术:全国登记的结果。","authors":"Enrique Rodríguez de Santiago , Alberto Herreros-de-Tejada , Eduardo Albéniz , Felipe Ramos Zabala , Gloria Fernández-Esparrach , Oscar Nogales , Pedro Rosón , Beatriz Peñas García , Hugo Uchima , Álvaro Terán , Joaquín Rodríguez Sánchez , Diego de Frutos , Sofía Parejo Carbonell , José Santiago , José Díaz Tasende , Charly Guarner Argente , Pedro de María Pallarés , Ana Amorós , Daniel Barranco , Daniel Álvarez de Castro , José Carlos Marín-Gabriel","doi":"10.1016/j.gastrohep.2023.02.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and aims</h3><p>The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique.</p></div><div><h3>Material and methods</h3><p>Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection.</p></div><div><h3>Results</h3><p>A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (<em>n</em> <!-->=<!--> <!-->79; 95%<!--> <!-->CI: 68%-84%) and 63.7% (<em>n</em> <!-->=<!--> <!-->65; 95%<!--> <!-->CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (<em>n</em> <!-->=<!--> <!-->55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (<em>n</em> <!-->=<!--> <!-->25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14<!--> <!-->months, 20<!--> <!-->patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%).</p></div><div><h3>Conclusions</h3><p>In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.</p></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implementación de la disección endoscópica submucosa esofágica en España: resultados del registro nacional\",\"authors\":\"Enrique Rodríguez de Santiago , Alberto Herreros-de-Tejada , Eduardo Albéniz , Felipe Ramos Zabala , Gloria Fernández-Esparrach , Oscar Nogales , Pedro Rosón , Beatriz Peñas García , Hugo Uchima , Álvaro Terán , Joaquín Rodríguez Sánchez , Diego de Frutos , Sofía Parejo Carbonell , José Santiago , José Díaz Tasende , Charly Guarner Argente , Pedro de María Pallarés , Ana Amorós , Daniel Barranco , Daniel Álvarez de Castro , José Carlos Marín-Gabriel\",\"doi\":\"10.1016/j.gastrohep.2023.02.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and aims</h3><p>The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique.</p></div><div><h3>Material and methods</h3><p>Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection.</p></div><div><h3>Results</h3><p>A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (<em>n</em> <!-->=<!--> <!-->79; 95%<!--> <!-->CI: 68%-84%) and 63.7% (<em>n</em> <!-->=<!--> <!-->65; 95%<!--> <!-->CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (<em>n</em> <!-->=<!--> <!-->55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (<em>n</em> <!-->=<!--> <!-->25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14<!--> <!-->months, 20<!--> <!-->patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%).</p></div><div><h3>Conclusions</h3><p>In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.</p></div>\",\"PeriodicalId\":12802,\"journal\":{\"name\":\"Gastroenterologia y hepatologia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gastroenterologia y hepatologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0210570523000420\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastroenterologia y hepatologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0210570523000420","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Implementación de la disección endoscópica submucosa esofágica en España: resultados del registro nacional
Introduction and aims
The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique.
Material and methods
Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection.
Results
A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n = 79; 95% CI: 68%-84%) and 63.7% (n = 65; 95% CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n = 55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n = 25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14 months, 20 patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%).
Conclusions
In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.
期刊介绍:
Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.