347 Multicentre Long-Term Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Neoplasia Across Four European Tertiary Centres

Abstract Aim To analyse technical and long-term outcomes from a large western multicentre cohort of Endoscopic Submucosal Dissection (ESD) for early esophageal squamous cell carinoma (ESCC). Method Multicentre retrospective cohort study to evaluate the outcomes of ESD for ESCC from four tertiary centres across Europe. Data from consecutive patients were collected between 2013 to 2024. Outcomes were curative resection rate, R0 resection rate, technical success rate, stricture rate and survival. Results 135 ESDs were carried out for ESCC on 124 patients. Median survival 56 months (95% CI 30-74 months). Median age 69 (range 33-85, 53 males, 44 females). Histological analysis of these lesions showed: 39 had T1a, 48 had T1b, 44 had HGD, 4 had LGD. En bloc resection rate 97.1% (95%CI 94%-100%). R0 resection rate for cancer was 91% (95%CI 86%-94%). Overall, the technical success rate 99% (95% CI 95%-99%). Curative resection rate 52% (95% CI 44%-63%). Non curative patients (48%;95% CI 40%-58% of ESDs) proceeded to either endoscopic follow up or additional treatment (chemoradiotherapy/ esophagecyomy). Interestingly, no survival benefit was seen between the endoscopic follow up and additional treatment groups. Stricture rate (28%;95% CI 21%-36%) correlated with lesion length, resection time and circumferentiality of ESD (p<0.01). Overall, 5-year survival was 80% (95%CI 74%-89%). 5-year ESCC- specific survival of 95.3% (95% CI 91%-99%). Conclusions We demonstrate the effective, safe ESD for ESCC with comparable long-term survival in a large multicentre European cohort. Following non curative ESD additional treatment did not convey an obvious survival benefit compared to endoscopic surveillance alone.