High Success Rates for Endoscopic Submucosal Dissection in Prospective North American Study

High Success Rates for Endoscopic Submucosal Dissection in Prospective North American Study

Douglas K. Rex, MD, MASGE, reviewing Draganov PV, et al. Gastroenterology 2021 Feb 18.

There are limited data on success rates of endoscopic submucosal dissection (ESD) in North America. In this study, 10 centers in the United States and Canada reported their experience performing ESD in 692 patients with lesions in the esophagus (n=181), stomach (n=101), duodenum (n=110), colon (n=211), or rectum (n=188). 

Overall en bloc, R0, and curative resection rates were 91.5%, 84.2%, and 78.3%, respectively. Delayed bleeding occurred in 2.3% of the patients and perforation in 2.9%, but only 1 patient with a delayed right-sided colon perforation required surgery. The presence of severe submucosal fibrosis predicted resection failures and adverse events. Among the other findings: a depressed morphology was associated with failed curative resection; prior attempts at endoscopic mucosal resection and tattoos were associated with severe submucosal fibrosis; the overall recurrence rate was 5.8%; either a clip or suture closure was used in 24% of cases; 33.1% of patients were admitted, with a mean stay of 1.3 days; and colonic location was associated with failed en bloc resection (odds ratio, 8).

Invasive cancer rates were 10.6% in the rectum and 3.3% in the colon.

Douglas K. Rex, MD, FASGE


These data indicate that North American experts in ESD can achieve en bloc, R0, and curative resection rates that meet international standards. These data do not make a strong case for colonic ESD, with a number needed to treat of at least 30 to prevent 1 surgery, the lowest numerical en bloc resection rate at 85.8%, and the highest perforation rate at 4.7%.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Draganov PV, Aihara H, Karasik MS, et al. Endoscopic submucosal dissection (ESD) in North America: a large prospective multicenter study. Gastroenterology 2021 Feb 18. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2021.02.036)

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