Endoscopic Submucosal Dissection in Europe: Results of 1000 neoplastic lesions from the German ESD Registry.

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Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD.The German ESD registry is a prospective uncontrolled multicenter study. Over a 35-month-period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤ 20 ESDs/year), middle-volume (20-50/year), and high-volume centers (>50/year). A multivariate analysis investigating risk factors for non-curative resection was performed.Overall, en bloc, R0 and curative resection rates of 92.4% (95%CI 0.90-0.94), 78.8% (95%CI 0.76-0.81) and 72.3% (95%CI 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI 0.067-0.102) while the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, recurrence rates and lower complication rates than middle or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for non-curative ESD.In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center’s yearly case volume.

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Authors: Carola Fleischmann, Andreas Probst, Alanna Ebigbo, Siegbert Faiss, Brigitte Schumacher, H-P Allgaier, F L Dumoulin, Ingo Steinbrueck, Michael Anzinger, Joerg Marienhagen, Anna Muzalyova, Helmut Messmann