Published online Dec 16, 2017. doi: 10.4253/wjge.v9.i12.561
Peer-review started: September 8, 2017
First decision: September 26, 2017
Revised: October 18, 2017
Accepted: November 15, 2017
Article in press: November 15, 2017
Published online: December 16, 2017
Processing time: 90 Days and 12.3 Hours
Endoscopic submucosal dissection (ESD) is a minimally invasive technique used to treat early superficial lesions of the gastrointestinal tract. It is popular in Far East countries where its outstanding efficacy has been proven by multiple studies. Technological advances have recently made ESD more accessible worldwide. In the United Kingdom, this intervention is still relatively new and local evidence to support its use still scarce.
This study aims to evaluate the application of ESD in Caucasian patients in the United Kingdom and seeks to compensate for the lack of evidence in the literature in favour of its use in this country. Larger scale studies will be required in the future.
This study constitutes a step forward in providing the evidence necessary to support the application of ESD among Caucasian patients in the United Kingdom as well as to help produce standardised clinical guidelines to inform local clinical practice for this relatively new intervention.
This retrospective study uses data obtained from the Department of Gastroenterology at Salford Royal NHS Foundation Trust in the United Kingdom, a tertiary centre for gastrointestinal interventions. Data for a period of 2 years has been analysed using Microsoft Excel.
Of the 21 lesions resected with ESD, 6 achieved curative resection (CR), 10 were “indefinite” for CR or non-CR, and 5 were considered non-CR. A favourable long-term outcome was observed in the CR and “indefinite” groups, with clearance of dysplasia observed overall in 81.8% of patients who had had at least one endoscopic follow-up. ESD also changed the histological diagnoses in 66.6% of cases. These results are promising and provide early evidence in favour of the use of ESD in the United Kingdom.
ESD as applied to Caucasian patients in the United Kingdom can produce promising results as shown by this study. There have not been similar studies in the United Kingdom in the past and thus larger scale studies are required to fully evaluate the efficacy and safety profile of ESD as applied to upper gastrointestinal cancers.
To better assess the effectiveness of ESD at clearing early neoplastic lesions of the stomach and other upper gastrointestinal cancers among Caucasian patients in the United Kingdom, a prospective study involving a larger sample of such patients is required.