Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America

Saowanee Ngamruengphong; Lorenzo Ferri; Hiroyuki Aihara; Peter V. Draganov; Dennis J. Yang; Yaseen B. Perbtani; Terry L. Jue; Craig A. Munroe; Eshandeep S. Boparai; Neal A. Mehta; Amit Bhatt; Nikhil A. Kumta; Mohamed O. Othman; Michael Mercado; Huma Javaid; Abdul Aziz Aadam; Amanda Siegel; Theodore W. James; Ian S. Grimm; John M. DeWitt; Aleksey Novikov; Alexander Schlachterman; Thomas Kowalski; Jason Samarasena; Rintaro Hashimoto; Nabil El Hage Chehade; John Lee; Kenneth Chang; Bailey Su; Michael B. Ujiki; Amit Mehta; Reem Z. Sharaiha; David L. Carr-Locke; Alex Chen; Michael Chen; Yen I. Chen; Mir Milad Pourmousavi Khoshknab; Rui Wang; Tossapol Kerdsirichairat; Yutaka Tomizawa; Daniel von Renteln; Vivek Kumbhari; Mouen A. Khashab; Robert Bechara; Michael Karasik; Neej J. Patel; Norio Fukami; Makoto Nishimura; Yuri Hanada; Louis M. Wong Kee Song; Monika Laszkowska; Andrew Y. Wang; Joo Ha Hwang; Shai Friedland; Amrita Sethi; Antony N. Kalloo

doi:10.1016/j.cgh.2020.06.023

Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America

Saowanee Ngamruengphong^*, Lorenzo Ferri, Hiroyuki Aihara, Peter V. Draganov, Dennis J. Yang, Yaseen B. Perbtani, Terry L. Jue, Craig A. Munroe, Eshandeep S. Boparai, Neal A. Mehta, Amit Bhatt, Nikhil A. Kumta, Mohamed O. Othman, Michael Mercado, Huma Javaid, Abdul Aziz Aadam, Amanda Siegel, Theodore W. James, Ian S. Grimm, John M. DeWittAleksey Novikov, Alexander Schlachterman, Thomas Kowalski, Jason Samarasena, Rintaro Hashimoto, Nabil El Hage Chehade, John Lee, Kenneth Chang, Bailey Su, Michael B. Ujiki, Amit Mehta, Reem Z. Sharaiha, David L. Carr-Locke, Alex Chen, Michael Chen, Yen I. Chen, Mir Milad Pourmousavi Khoshknab, Rui Wang, Tossapol Kerdsirichairat, Yutaka Tomizawa, Daniel von Renteln, Vivek Kumbhari, Mouen A. Khashab, Robert Bechara, Michael Karasik, Neej J. Patel, Norio Fukami, Makoto Nishimura, Yuri Hanada, Louis M. Wong Kee Song, Monika Laszkowska, Andrew Y. Wang, Joo Ha Hwang, Shai Friedland, Amrita Sethi, Antony N. Kalloo

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

38 Scopus citations

Abstract

Background & Aims: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.

Original language	English (US)
Pages (from-to)	1611-1619.e1
Journal	Clinical Gastroenterology and Hepatology
Volume	19
Issue number	8
DOIs	https://doi.org/10.1016/j.cgh.2020.06.023
State	Published - Aug 2021

Funding

Conflicts of interest The following authors disclose the following: Amrita Sethi has served as a consultant for Boston Scientific and Olympus. Amit Bhatt has served as a speaker for Aries Pharmaceuticals and a consultant for Medtronic. Nikhil A. Kumta has served as a consultant for Apollo Endosurgery, Boston Scientific, and Olympus. Mouen A. Khashab has served on the medical advisory board for Boston Scientific and Olympus America; and served as a consultant for Boston Scientific, Olympus America, and Medtronic. Anthony N. Kalloo is a founding member, owns equity in, and has served as a consultant for Apollo Endosurgery. Dennis Yang has served as a consultant for Boston Scientific, Lumendi, and US Endoscopy. Peter V. Draganov has served as a consultant for Boston Scientific, Lumendi, Cook, Olympus, and Microtech. Vivek Kumbhari has served as a consultant for Medtronic, Reshape Lifesciences, Boston Scientific, Pentax Medical, and Apollo Endosurgery; and has received research support from ERBE USA and Apollo Endosurgery. Saowanee Ngamruengphong has served as a consultant for Boston Scientific. Yen-I Chen has served as a consultant for Boston Scientific. Daniel von Renteln has received research funding from ERBE, Ventage, Pendopharm; and Pentax; and served as a consultant for Boston Scientific and Pendopharm. Hiroyuki Aihara has served as a consultant for Olympus America, Boston Scientific, Fujifilm Medical Systems, Auris Health, and Lumendi. Michael B. Ujiki has served as a consultant for Olympus and Boston Scientific. Ian Grimm has served as a consultant for Boston Scientific. Mohamed O. Othman has served as a consultant for AbbVie, Boston Scientific, Olympus Corporation of America, and Lumendi. Reem Z. Sharaiha has served as a consultant for Boston Scientific and Apollo Endosurgery. Kenneth Chang has served as a consultant for or received grant support from Apollo, Boston Scientific, ERBE, C2 Therapeutics, Cook, Covidien, Endogastric Solutions, Mederi, Medtronic, Olympus, Ovesco, Pentax, and Torax. Norio Fukami has served as a consultant for Boston Scientific and Olympus America. Makoto Nishimura has served as a consultant for Boston Scientific. The remaining authors disclose no conflicts. Conflicts of interest The following authors disclose the following: Amrita Sethi has served as a consultant for Boston Scientific and Olympus. Amit Bhatt has served as a speaker for Aries Pharmaceuticals and a consultant for Medtronic. Nikhil A. Kumta has served as a consultant for Apollo Endosurgery, Boston Scientific, and Olympus. Mouen A. Khashab has served on the medical advisory board for Boston Scientific and Olympus America; and served as a consultant for Boston Scientific, Olympus America, and Medtronic. Anthony N. Kalloo is a founding member, owns equity in, and has served as a consultant for Apollo Endosurgery. Dennis Yang has served as a consultant for Boston Scientific, Lumendi, and US Endoscopy. Peter V. Draganov has served as a consultant for Boston Scientific, Lumendi, Cook, Olympus, and Microtech. Vivek Kumbhari has served as a consultant for Medtronic, Reshape Lifesciences, Boston Scientific, Pentax Medical, and Apollo Endosurgery; and has received research support from ERBE USA and Apollo Endosurgery. Saowanee Ngamruengphong has served as a consultant for Boston Scientific. Yen-I Chen has served as a consultant for Boston Scientific. Daniel von Renteln has received research funding from ERBE, Ventage, Pendopharm; and Pentax; and served as a consultant for Boston Scientific and Pendopharm. Hiroyuki Aihara has served as a consultant for Olympus America, Boston Scientific, Fujifilm Medical Systems, Auris Health, and Lumendi. Michael B. Ujiki has served as a consultant for Olympus and Boston Scientific. Ian Grimm has served as a consultant for Boston Scientific. Mohamed O. Othman has served as a consultant for AbbVie, Boston Scientific, Olympus Corporation of America, and Lumendi. Reem Z. Sharaiha has served as a consultant for Boston Scientific and Apollo Endosurgery. Kenneth Chang has served as a consultant for or received grant support from Apollo, Boston Scientific, ERBE, C2 Therapeutics, Cook, Covidien, Endogastric Solutions, Mederi, Medtronic, Olympus, Ovesco, Pentax, and Torax. Norio Fukami has served as a consultant for Boston Scientific and Olympus America. Makoto Nishimura has served as a consultant for Boston Scientific. The remaining authors disclose no conflicts.

Keywords

Dysplasia
EGC
Endoscopic resection
Stomach cancer

ASJC Scopus subject areas

Hepatology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.cgh.2020.06.023

Cite this

Ngamruengphong, S., Ferri, L., Aihara, H., Draganov, P. V., Yang, D. J., Perbtani, Y. B., Jue, T. L., Munroe, C. A., Boparai, E. S., Mehta, N. A., Bhatt, A., Kumta, N. A., Othman, M. O., Mercado, M., Javaid, H., Aadam, A. A., Siegel, A., James, T. W., Grimm, I. S., ... Kalloo, A. N. (2021). Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America. Clinical Gastroenterology and Hepatology, 19(8), 1611-1619.e1. https://doi.org/10.1016/j.cgh.2020.06.023

@article{f4beca1826e84d1c9af81e2d5440d4b5,

title = "Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America",

abstract = "Background & Aims: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.",

keywords = "Dysplasia, EGC, Endoscopic resection, Stomach cancer",

author = "Saowanee Ngamruengphong and Lorenzo Ferri and Hiroyuki Aihara and Draganov, {Peter V.} and Yang, {Dennis J.} and Perbtani, {Yaseen B.} and Jue, {Terry L.} and Munroe, {Craig A.} and Boparai, {Eshandeep S.} and Mehta, {Neal A.} and Amit Bhatt and Kumta, {Nikhil A.} and Othman, {Mohamed O.} and Michael Mercado and Huma Javaid and Aadam, {Abdul Aziz} and Amanda Siegel and James, {Theodore W.} and Grimm, {Ian S.} and DeWitt, {John M.} and Aleksey Novikov and Alexander Schlachterman and Thomas Kowalski and Jason Samarasena and Rintaro Hashimoto and Chehade, {Nabil El Hage} and John Lee and Kenneth Chang and Bailey Su and Ujiki, {Michael B.} and Amit Mehta and Sharaiha, {Reem Z.} and Carr-Locke, {David L.} and Alex Chen and Michael Chen and Chen, {Yen I.} and {Pourmousavi Khoshknab}, {Mir Milad} and Rui Wang and Tossapol Kerdsirichairat and Yutaka Tomizawa and {von Renteln}, Daniel and Vivek Kumbhari and Khashab, {Mouen A.} and Robert Bechara and Michael Karasik and Patel, {Neej J.} and Norio Fukami and Makoto Nishimura and Yuri Hanada and {Wong Kee Song}, {Louis M.} and Monika Laszkowska and Wang, {Andrew Y.} and Hwang, {Joo Ha} and Shai Friedland and Amrita Sethi and Kalloo, {Antony N.}",

note = "Publisher Copyright: {\textcopyright} 2021 AGA Institute",

year = "2021",

month = aug,

doi = "10.1016/j.cgh.2020.06.023",

language = "English (US)",

volume = "19",

pages = "1611--1619.e1",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

number = "8",

}

Ngamruengphong, S, Ferri, L, Aihara, H, Draganov, PV, Yang, DJ, Perbtani, YB, Jue, TL, Munroe, CA, Boparai, ES, Mehta, NA, Bhatt, A, Kumta, NA, Othman, MO, Mercado, M, Javaid, H, Aadam, AA, Siegel, A, James, TW, Grimm, IS, DeWitt, JM, Novikov, A, Schlachterman, A, Kowalski, T, Samarasena, J, Hashimoto, R, Chehade, NEH, Lee, J, Chang, K, Su, B, Ujiki, MB, Mehta, A, Sharaiha, RZ, Carr-Locke, DL, Chen, A, Chen, M, Chen, YI, Pourmousavi Khoshknab, MM, Wang, R, Kerdsirichairat, T, Tomizawa, Y, von Renteln, D, Kumbhari, V, Khashab, MA, Bechara, R, Karasik, M, Patel, NJ, Fukami, N, Nishimura, M, Hanada, Y, Wong Kee Song, LM, Laszkowska, M, Wang, AY, Hwang, JH, Friedland, S, Sethi, A & Kalloo, AN 2021, 'Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America', Clinical Gastroenterology and Hepatology, vol. 19, no. 8, pp. 1611-1619.e1. https://doi.org/10.1016/j.cgh.2020.06.023

TY - JOUR

T1 - Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America

AU - Ngamruengphong, Saowanee

AU - Ferri, Lorenzo

AU - Aihara, Hiroyuki

AU - Draganov, Peter V.

AU - Yang, Dennis J.

AU - Perbtani, Yaseen B.

AU - Jue, Terry L.

AU - Munroe, Craig A.

AU - Boparai, Eshandeep S.

AU - Mehta, Neal A.

AU - Bhatt, Amit

AU - Kumta, Nikhil A.

AU - Othman, Mohamed O.

AU - Mercado, Michael

AU - Javaid, Huma

AU - Aadam, Abdul Aziz

AU - Siegel, Amanda

AU - James, Theodore W.

AU - Grimm, Ian S.

AU - DeWitt, John M.

AU - Novikov, Aleksey

AU - Schlachterman, Alexander

AU - Kowalski, Thomas

AU - Samarasena, Jason

AU - Hashimoto, Rintaro

AU - Chehade, Nabil El Hage

AU - Lee, John

AU - Chang, Kenneth

AU - Su, Bailey

AU - Ujiki, Michael B.

AU - Mehta, Amit

AU - Sharaiha, Reem Z.

AU - Carr-Locke, David L.

AU - Chen, Alex

AU - Chen, Michael

AU - Chen, Yen I.

AU - Pourmousavi Khoshknab, Mir Milad

AU - Wang, Rui

AU - Kerdsirichairat, Tossapol

AU - Tomizawa, Yutaka

AU - von Renteln, Daniel

AU - Kumbhari, Vivek

AU - Khashab, Mouen A.

AU - Bechara, Robert

AU - Karasik, Michael

AU - Patel, Neej J.

AU - Fukami, Norio

AU - Nishimura, Makoto

AU - Hanada, Yuri

AU - Wong Kee Song, Louis M.

AU - Laszkowska, Monika

AU - Wang, Andrew Y.

AU - Hwang, Joo Ha

AU - Friedland, Shai

AU - Sethi, Amrita

AU - Kalloo, Antony N.

PY - 2021/8

Y1 - 2021/8

N2 - Background & Aims: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.

AB - Background & Aims: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods: We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results: Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions: ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.

KW - Dysplasia

KW - EGC

KW - Endoscopic resection

KW - Stomach cancer

UR - http://www.scopus.com/inward/record.url?scp=85108523624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85108523624&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2020.06.023

DO - 10.1016/j.cgh.2020.06.023

M3 - Article

C2 - 32565290

AN - SCOPUS:85108523624

SN - 1542-3565

VL - 19

SP - 1611-1619.e1

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 8

ER -

Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America

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UN SDGs

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