OGC SO11 - Impact Evaluation of Endoscopic Mucosal Resection in the Foregut in a Tertiary Centre in the United Kingdom (UK)

Abstract Background Endoscopic mucosal resection (EMR) has emerged as a crucial technique for managing early-stage lesions in the oesophagus and stomach, encompassing precancerous and cancerous conditions.1 With fewer complications and excellent 5-year survival rates, EMR has shown potential as a less-invasive alternative to surgical resections.1 EMR achieves higher accuracy with its ability to obtain more profound and better quality tissue samples compared to conventional biopsies, which facilitates multidisciplinary team (MDT) discussions regarding treatment decisions.1 This study aims to evaluate the impact of EMR performed in an Oesophago-Gastric Cancer tertiary centre in the UK. Method This is a retrospective service evaluation of patients who underwent EMR from March 2021 to March 2024. A sample size of 73 EM (n=73) is identified. Data were collected from medical and endoscopic records, which includes patient’s demographics, American Society of Anaesthesiologists (ASA) grade, EMR indication, histology report and MDT outcome. EMRs performed were categorised into oesophageal, gastric and duodenal. Three main referral indications were identified; ‘polyp’, ‘dysplastic nodule in Barrett’s oesophagus’ and ‘possible early malignancy’. MDT outcomes were analysed thematically. Results Of the seventy-three patients identified, 78% is male and mean age at 71 years. Most patients (81%) are classified as ASA Grade 2. Polyp is identified in 37 patients (51%), making up the most common referral indication. 49% of the EMR were gastric, with remaining being oesophageal (41%) and duodenal (11%). 26% of histology results showed benign disease, 40% dysplastic disease, and 34% malignant. From histology reports, 47% of the EMRs achieved complete clearance margins. 28 patients (38%) were discharged with no further interventions and 12 patients (16%) received repeat EMR. 4 main themes were identified from MDT outcomes, with 43.8% patients needing surveillance endoscopy, 16.7% patients recommended for surgical intervention and repeated EMR each. Conclusion EMR has shown to be effective as a reference for further treatment decisions, especially for MDT discussions. It has been proven that EMR can be therapeutic in providing complete resection, particularly for benign and early dysplastic diseases.