Advanced Endoscopic Techniques

Background and Aim: Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure which employs en-bloc dissection technique to remove premalignant or early malignant gastrointestinal lesions.In Japan, ESD is considered as first line treatment for early gastrointestinal neoplasms, yet the wide adoption of ESD in the West has been slow.Barriers include the technical difficulty of ESD, lower prevalence of early gastric cancer in the West, and the lack of training opportunities.We know that gastric location is the easiest location to start training in ESD whereas colorectal ESD is more challenging.The aim of this study was to assess the early experience with ESD at Austin Health.Methods: A retrospective analysis was conducted on 31 consecutive gastrointestinal lesions in 27 patients who underwent ESD from June 2020 to April 2023 at Austin Health, Melbourne Australia.Clinical and procedural data, complications, and the efficacy and efficiency of the ESD procedure were evaluated.Results: Twenty-seven patients (12 females and 15 males) were enrolled in the study, with a mean age of 72.0 years.Overall, thirty-one lesions were resected, including 16 gastric lesions, 6 oesophageal lesions and 9 colorectal lesions.The mean size of the lesions was 35.8mm and the mean resected base area was 12.0cm2 .In the total cohort, en-bloc resection rate was 96.8%.Final ESD histology upstaged the initial diagnosis in four lesions based on pre-ESD pinch biopsies and imaging.Eleven malignant lesions were found in the final pathology.Six complications were reported in our study, including two cases of intraoperative perforation and four cases of delayed bleeding (all the complications were managed medically/ endoscopically).The mean hospital stay was 1.6 days for all patients, and 19 patients were discharged after an overnight admission. Conclusion:ESD is an effective and safe treatment for gastrointestinal neoplasms in an Australian tertiary centre and our early treatment outcomes were comparable to recently published large study data.Outcomes are likely to progressively improve with further experience.