Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei prämalignen und malignen gastrointestinalen Neoplasien

Introduction: Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre. Material and Methods: Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012). Results: ESD was technically possible in 93.5 %. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7 %, 74.4 %, 67.4 % and 65.1 %, respectively. The complication rate was 13 %. In the second period en-bloc and R0 en-bloc resection rates increased from 81 % to 100 % and, respectively, from 52.4 % to 81.8 %. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10 %. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred. Discussion: Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany.