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Su1493 Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Squamous Esophageal Neoplasms: a Systematic Review and Meta-Analysis
Abstracts
Characteristics Received Neoadjuvant Therapy Yes No Anatomical Site of Cancer Upper third Middle third Lower third GE junction Stage 1 2A 2B 3 4 Histology Adenocarcinoma Squamous Other Grade Well differentiated Moderately differentiated Poorly differentiated Undifferentiated GX: Unspecified Unknown Time to recurrence after surgery (Mean ⫾ Std in Months) Last contact since surgery (Mean ⫾ Std in Months) Vital Status Alive Deceased
No recurrence (Nⴝ257) N%
Recurred (Nⴝ90)
N%
P
147 110
57.20 42.80
75 15
83.33 <0.001 16.67
5 16 159 77
1.95 6.23 61.87 29.96
0 4 50 36
0 4.44 55.56 40.00
57 48 58 88 6
22.18 18.68 22.57 34.23 2.33
6 11 13 49 11
6.67 <0.001 12.22 14.44 54.44 12.22
226 24 3
87.94 9.34 1.17
80 8 1
88.89 8.89 1.11
0.730
37 91 58 0 30 41 N/A
14.40 35.41 22.57 0.00 11.67 15.95 N/A
5 31 29 1 12 12 17.46 ⫾ 16.09
5.56 34.44 32.22 1.11 13.33 13.33 N/A
0.064
44.31 ⫾ 25.27
193 64
0.247
N/A
N/A 31.00 ⫾ 20.43 N/A <0.001
75.10 24.90
24 66
26.67 <0.001 73.33
Table 2. Recurrence by site and imaging. Site of Recurrence and Modality of Detection Site of Recurrence Total Recurrence Involving Esophagus Esophagus Only Esophagus ⫹ Regional Recurrence Esophagus ⫹ Distant Recurrence All Regional (i.e. Mediastinal or Celiac adenopathy) Recurrence All Distant Recurrence All Regional or Distant Recurrence Modality of Detection Total Detected by EGD Detected by EGD only Detected by CT Detected by PET Detected by MRI Detected by CT or PET or MRI Unknown Modality of Detection
Nⴝ90
N%
18
20.00
11 2 5 4
12.22 2.22 5.56 4.44
75 79
83.33 87.78
12 2 50 52 10 76 12
13.33 2.22 55.56 57.78 11.11 84.44 13.33
Su1494 Repeat ESD for Managing Metachronous Superficial Esophageal Squamous Cell Carcinoma in Patients With Scheduled Endoscopic Surveillance Yasuaki Nagami*1, Masatsugu Shiba1, Yasuhiro Fujiwara1, Masaki Ominami1, Shusei Fukunaga1, Satoshi Sugimori1, Hirohisa Machida2,1, Mitsue Sogawa1, Hirokazu Yamagami1, Tetsuya Tanigawa1, Kenji Watanabe1, Toshio Watanabe1, Kazunari Tominaga1, Tetsuo Arakawa1 1 Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka city, Japan; 2Gastroenterology, Machida Gastrointestinal Hospital, Osaka City, Japan Background/Aims: Recently, endoscopic submucosal dissection (ESD) has become accepted due to its high quality control of the treatment for superficial esophageal squamous cell carcinoma (ESCC) without regional lymph node metastasis. However, the residual esophageal mucosa after ESD has maintained a high potential for the development of metachronous ESCC (MEC). The aim of this study was to evaluate whether scheduled endoscopic surveillance could control the development of MEC and efficacy of a repeat ESD for MEC. Methods: Between May 2004 and December 2011, a total of 196 patients with 269 superficial ESCC underwent ESD in our hospital. Fifty-five patients who received chemotherapy, radiotherapy, chemoradiotherapy or esophagectomy were excluded. Consequently, 141 patients were enrolled in this study. Endoscopic surveillance using chromoendoscopy with iodine staining was scheduled at 2, 6, 12, and every 6 months after the initial ESD, and repeat ESD was performed when MEC was detected. We defined a second multiple cancers found at first endoscopic surveillance using chromoendoscopy with iodine staining after the initial ESD as synchronous ESCC and at after that as MEC. The cumulative incidence rates and long term outcome of MEC were calculated using KaplenMeier method. Results: Of 141 patients, 115 and 26 patients had solitary ESCC and synchronous multiple ESCC at the initial ESD. MEC were detected in 16 (11.3%) patients among median follow up period of 824 (range 7- 2984) days. The median interval to detection of MEC after the initial ESD was 477 (range, 178-1746) days. The cumulative incidence rate of MEC at 1, 2 and 3 years was 4.9%, 9.9% and 16.2%, respectively. The incidence rate of MEC did not differ between solitary and synchronous ESCC at the initial ESD (Log Rank test p ⫽ 0.81). All patients underwent ESD with cancer free margin and no serious complications such as delayed bleeding and perforation were encountered. One patient with muscularis mucosae invasion and no lympho-vascular invasion was received additional chemoradiotherapy. There was no recurrence during the follow-up period of 1127 days in median and the survival rate was not significant difference with patients without MEC (Log Rank test p ⫽ 0.28). Conclusions: MEC was detected in 11.3% of patients with ESD treatment for ESCC. Repeat ESD was effective for the management of MEC in patients with scheduled endoscopic surveillance.
Su1495 ESD Optimization in the Esophagus Using the Tunnel Method : Comparative Study With the Standard ESD Technique Mathieu Pioche*1, Laetitia Mais1, Olivier Guillaud1, Valerie Hervieu2, Jean Christophe Saurin1, Thierry Ponchon1, Vincent Lepilliez1 1 Gastroenterology, Pavillon H Hôpital Edouard Herriot, Lyon, France; 2 Histology, Hopital Edouard Herriot, Lyon, France
Su1493 Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Squamous Esophageal Neoplasms: a Systematic Review and Meta-Analysis Joon Sung Kim*, Byung Wook Kim Internal Medicine, The Catholic Univeresity of Korea, Incheon, Republic of Korea Background/Aim: Endoscopic submucosal dissection (ESD) has been proposed as a new treatment modality for superficial sqamous esophageal neoplasms (SSEN). However, data on the efficacy and safety of ESD for this lesion are still controversial. The aim of this current systematic review and meta-analysis was to assess the efficacy and safety of ESD for SSEN. Methods: A comprehensive
www.giejournal.org
literature search was performed to identify all relevant studies that performed ESD for esophageal lesions. Several databases were searched including MEDLINE (through PubMed), EMBASE, and the Cochrane Library for the period 1999 to 2012. The medical terms “endoscopic submucosal dissection,” “esophagus,” “esophageal,” were used in the search. We also searched the reference of screened articles to identify any additional studies. Results: A total of 17 studies (15 Asian, 2 European) provided data on 865 ESD-treated lesions. The pooled estimate of complete resection rate was 89.7% (95% CI; 85%-93%). The pooled estimate of en bloc resection was 96% (95% CI; 93%-98%). The pooled estimates of complications of ESD such as bleeding, perforation and stenosis were 2%, 5%, 12%, respectively. Subgroup analysis comparing the complete resection rate from Japan and other countries did not show any statistical difference. Conclusion: ESD appeared to be an extremely effective technique to achieve complete resection of SSEN. The very low rate of complications also shows the potential safety of this approach.
Introduction: Endoscopic Submucosal Dissection (ESD) allows “en bloc” R0 resection for esophageal neoplastic lesions larger than 15 mm. However, it is considered as a high risk and time consuming method. Tunnel technique consists first to perform an incision at the lower and upper edges of the lesion, and then to create a “Tunnel” in the submucosal space between mucosa and muscle in order to join both incisions, and to finish by lateral incisions. The main advantage of the “Tunnel” in comparison to standard ESD is to more easily
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB345
Characteristics Received Neoadjuvant Therapy Yes No Anatomical Site of Cancer Upper third Middle third Lower third GE junction Stage 1 2A 2B 3 4 Histology Adenocarcinoma Squamous Other Grade Well differentiated Moderately differentiated Poorly differentiated Undifferentiated GX: Unspecified Unknown Time to recurrence after surgery (Mean ⫾ Std in Months) Last contact since surgery (Mean ⫾ Std in Months) Vital Status Alive Deceased
No recurrence (Nⴝ257) N%
Recurred (Nⴝ90)
N%
P
147 110
57.20 42.80
75 15
83.33 <0.001 16.67
5 16 159 77
1.95 6.23 61.87 29.96
0 4 50 36
0 4.44 55.56 40.00
57 48 58 88 6
22.18 18.68 22.57 34.23 2.33
6 11 13 49 11
6.67 <0.001 12.22 14.44 54.44 12.22
226 24 3
87.94 9.34 1.17
80 8 1
88.89 8.89 1.11
0.730
37 91 58 0 30 41 N/A
14.40 35.41 22.57 0.00 11.67 15.95 N/A
5 31 29 1 12 12 17.46 ⫾ 16.09
5.56 34.44 32.22 1.11 13.33 13.33 N/A
0.064
44.31 ⫾ 25.27
193 64
0.247
N/A
N/A 31.00 ⫾ 20.43 N/A <0.001
75.10 24.90
24 66
26.67 <0.001 73.33
Table 2. Recurrence by site and imaging. Site of Recurrence and Modality of Detection Site of Recurrence Total Recurrence Involving Esophagus Esophagus Only Esophagus ⫹ Regional Recurrence Esophagus ⫹ Distant Recurrence All Regional (i.e. Mediastinal or Celiac adenopathy) Recurrence All Distant Recurrence All Regional or Distant Recurrence Modality of Detection Total Detected by EGD Detected by EGD only Detected by CT Detected by PET Detected by MRI Detected by CT or PET or MRI Unknown Modality of Detection
Nⴝ90
N%
18
20.00
11 2 5 4
12.22 2.22 5.56 4.44
75 79
83.33 87.78
12 2 50 52 10 76 12
13.33 2.22 55.56 57.78 11.11 84.44 13.33
Su1494 Repeat ESD for Managing Metachronous Superficial Esophageal Squamous Cell Carcinoma in Patients With Scheduled Endoscopic Surveillance Yasuaki Nagami*1, Masatsugu Shiba1, Yasuhiro Fujiwara1, Masaki Ominami1, Shusei Fukunaga1, Satoshi Sugimori1, Hirohisa Machida2,1, Mitsue Sogawa1, Hirokazu Yamagami1, Tetsuya Tanigawa1, Kenji Watanabe1, Toshio Watanabe1, Kazunari Tominaga1, Tetsuo Arakawa1 1 Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka city, Japan; 2Gastroenterology, Machida Gastrointestinal Hospital, Osaka City, Japan Background/Aims: Recently, endoscopic submucosal dissection (ESD) has become accepted due to its high quality control of the treatment for superficial esophageal squamous cell carcinoma (ESCC) without regional lymph node metastasis. However, the residual esophageal mucosa after ESD has maintained a high potential for the development of metachronous ESCC (MEC). The aim of this study was to evaluate whether scheduled endoscopic surveillance could control the development of MEC and efficacy of a repeat ESD for MEC. Methods: Between May 2004 and December 2011, a total of 196 patients with 269 superficial ESCC underwent ESD in our hospital. Fifty-five patients who received chemotherapy, radiotherapy, chemoradiotherapy or esophagectomy were excluded. Consequently, 141 patients were enrolled in this study. Endoscopic surveillance using chromoendoscopy with iodine staining was scheduled at 2, 6, 12, and every 6 months after the initial ESD, and repeat ESD was performed when MEC was detected. We defined a second multiple cancers found at first endoscopic surveillance using chromoendoscopy with iodine staining after the initial ESD as synchronous ESCC and at after that as MEC. The cumulative incidence rates and long term outcome of MEC were calculated using KaplenMeier method. Results: Of 141 patients, 115 and 26 patients had solitary ESCC and synchronous multiple ESCC at the initial ESD. MEC were detected in 16 (11.3%) patients among median follow up period of 824 (range 7- 2984) days. The median interval to detection of MEC after the initial ESD was 477 (range, 178-1746) days. The cumulative incidence rate of MEC at 1, 2 and 3 years was 4.9%, 9.9% and 16.2%, respectively. The incidence rate of MEC did not differ between solitary and synchronous ESCC at the initial ESD (Log Rank test p ⫽ 0.81). All patients underwent ESD with cancer free margin and no serious complications such as delayed bleeding and perforation were encountered. One patient with muscularis mucosae invasion and no lympho-vascular invasion was received additional chemoradiotherapy. There was no recurrence during the follow-up period of 1127 days in median and the survival rate was not significant difference with patients without MEC (Log Rank test p ⫽ 0.28). Conclusions: MEC was detected in 11.3% of patients with ESD treatment for ESCC. Repeat ESD was effective for the management of MEC in patients with scheduled endoscopic surveillance.
Su1495 ESD Optimization in the Esophagus Using the Tunnel Method : Comparative Study With the Standard ESD Technique Mathieu Pioche*1, Laetitia Mais1, Olivier Guillaud1, Valerie Hervieu2, Jean Christophe Saurin1, Thierry Ponchon1, Vincent Lepilliez1 1 Gastroenterology, Pavillon H Hôpital Edouard Herriot, Lyon, France; 2 Histology, Hopital Edouard Herriot, Lyon, France
Su1493 Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Squamous Esophageal Neoplasms: a Systematic Review and Meta-Analysis Joon Sung Kim*, Byung Wook Kim Internal Medicine, The Catholic Univeresity of Korea, Incheon, Republic of Korea Background/Aim: Endoscopic submucosal dissection (ESD) has been proposed as a new treatment modality for superficial sqamous esophageal neoplasms (SSEN). However, data on the efficacy and safety of ESD for this lesion are still controversial. The aim of this current systematic review and meta-analysis was to assess the efficacy and safety of ESD for SSEN. Methods: A comprehensive
www.giejournal.org
literature search was performed to identify all relevant studies that performed ESD for esophageal lesions. Several databases were searched including MEDLINE (through PubMed), EMBASE, and the Cochrane Library for the period 1999 to 2012. The medical terms “endoscopic submucosal dissection,” “esophagus,” “esophageal,” were used in the search. We also searched the reference of screened articles to identify any additional studies. Results: A total of 17 studies (15 Asian, 2 European) provided data on 865 ESD-treated lesions. The pooled estimate of complete resection rate was 89.7% (95% CI; 85%-93%). The pooled estimate of en bloc resection was 96% (95% CI; 93%-98%). The pooled estimates of complications of ESD such as bleeding, perforation and stenosis were 2%, 5%, 12%, respectively. Subgroup analysis comparing the complete resection rate from Japan and other countries did not show any statistical difference. Conclusion: ESD appeared to be an extremely effective technique to achieve complete resection of SSEN. The very low rate of complications also shows the potential safety of this approach.
Introduction: Endoscopic Submucosal Dissection (ESD) allows “en bloc” R0 resection for esophageal neoplastic lesions larger than 15 mm. However, it is considered as a high risk and time consuming method. Tunnel technique consists first to perform an incision at the lower and upper edges of the lesion, and then to create a “Tunnel” in the submucosal space between mucosa and muscle in order to join both incisions, and to finish by lateral incisions. The main advantage of the “Tunnel” in comparison to standard ESD is to more easily
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB345