Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: A multicenter retrospective cohort study

Background and study aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals. Patients and methods: Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed. Results: The median tumor size was 18mm (range 2-85mm). The median procedure time was 90 minutes (range 12-450 minutes). The en bloc resection and complete resection rates were 96.7% (95% confidence interval [CI] 94.4%-98.1%) and 84.5% (95%CI 80.5%-87.8%), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2% (95%CI 3.3%-7.9%), 1.6% (95%CI 0.7%-3.5%), 0%, and 7.1% (95%CI 4.9%-10.2%) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR]=4.04; P<0.01) and low volume institutions (OR=3.03; P =0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR=32.3; P<0.01). The procedure times significantly decreased in the later period of the study (P<0.01). Follow-up data (median 35 months; range 4-98 months) showed significant differences in overall survival (P=0.03) and recurrence-free survival (P<0.01) rates between patients with curative and noncurative resections. Conclusions: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.