Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study

Authors

  • Hideki Kobara Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan https://orcid.org/0000-0002-8508-827X
  • Yoichi Miyaoka Division of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
  • Yoshio Ikeda Division of Endoscopy, Ehime University, Matsuyama, Ehime, Japan
  • Takayoshi Yamada Department of Gastroenterology, Kochi Health Sciences Center, Kochi, Japan
  • Masashi Takata Department of Gastroenterology, Kochi Health Sciences Center, Kochi, Japan
  • Shintaro Fujihara Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Noriko Nishiyama Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Koji Fujita Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Joji Tani Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Nobuya Kobayashi Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Taiga Chiyo Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Tatsuo Yachida Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Keiichi Okano Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Yasuyuki Suzuki Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Hirohito Mori Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
  • Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan

DOI:

https://doi.org/10.15403/jgld-510

Keywords:

endoscopic submucosal dissection, gastrointestinal subepithelial lesions, small neuroendocrine tumors

Abstract

Background and Aims: Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis.

Methods: This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up.

Results: The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1–60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs.

Conclusions: ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.

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Published

2020-03-13

How to Cite

1.
Kobara H, Miyaoka Y, Ikeda Y, Yamada T, Takata M, Fujihara S, Nishiyama N, Fujita K, Tani J, Kobayashi N, Chiyo T, Yachida T, Okano K, Suzuki Y, Mori H, Masaki T. Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study. JGLD [Internet]. 2020 Mar. 13 [cited 2026 Jun. 15];29(1):41-9. Available from: https://jgld.ro/jgld/index.php/jgld/article/view/510

Issue

Vol. 29 No. 1: March 2020

Section

Original Article