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Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. 2024
Enrique Rodríguez de Santiago, and
Alberto Herreros-de-Tejada, and
Eduardo Albéniz, and
Felipe Ramos Zabala, and
Gloria Fernández-Esparrach, and
Oscar Nogales, and
Pedro Rosón, and
Beatriz Peñas García, and
Hugo Uchima, and
Álvaro Terán, and
Joaquín Rodríguez Sánchez, and
Diego de Frutos, and
Sofía Parejo Carbonell, and
José Santiago, and
José Díaz Tasende, and
Charly Guarner Argente, and
Pedro de María Pallarés, and
Ana Amorós, and
Daniel Barranco, and
Daniel Álvarez de Castro, and
Raquel Muñoz González, and
José Carlos Marín-Gabriel, and
Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España. Electronic address: e_rodriguez_de_santiago@hotmail.com.
OBJECTIVE 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. 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 14months, 20patients (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.
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