Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: A multicenter retrospective cohort study

Yoshiki Tsujii, Tsutomu Nishida, Osamu Nishiyama, Katsumi Yamamoto, Naoki Kawai, Shinjiro Yamaguchi, Takuya Yamada, Toshiyuki Yoshio, Shinji Kitamura, Takeshi Nakamura, Akihiro Nishihara, Hideharu Ogiyama, Masanori Nakahara, Masato Komori, Motohiko Kato, Yoshito Hayashi, Shinichiro Shinzaki, Hideki Iijima, Tomoki Michida, Masahiko TsujiiTetsuo Takehara

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background and study aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals. Patients and methods: Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed. Results: The median tumor size was 18mm (range 2-85mm). The median procedure time was 90 minutes (range 12-450 minutes). The en bloc resection and complete resection rates were 96.7% (95% confidence interval [CI] 94.4%-98.1%) and 84.5% (95%CI 80.5%-87.8%), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2% (95%CI 3.3%-7.9%), 1.6% (95%CI 0.7%-3.5%), 0%, and 7.1% (95%CI 4.9%-10.2%) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR]=4.04; P<0.01) and low volume institutions (OR=3.03; P =0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR=32.3; P<0.01). The procedure times significantly decreased in the later period of the study (P<0.01). Follow-up data (median 35 months; range 4-98 months) showed significant differences in overall survival (P=0.03) and recurrence-free survival (P<0.01) rates between patients with curative and noncurative resections. Conclusions: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

Original languageEnglish
Pages (from-to)775-783
Number of pages9
JournalEndoscopy
Volume47
Issue number9
DOIs
Publication statusPublished - 2015 Sep 1
Externally publishedYes

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Esophageal Neoplasms
Cohort Studies
Retrospective Studies
Confidence Intervals
Odds Ratio
Municipal Hospitals
Mediastinal Emphysema
Esophageal Stenosis
Survival
Multicenter Studies
Pneumonia
Pathologic Constriction
Endoscopic Mucosal Resection
Hemorrhage
Safety
Recurrence
Mortality
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Tsujii, Y., Nishida, T., Nishiyama, O., Yamamoto, K., Kawai, N., Yamaguchi, S., ... Takehara, T. (2015). Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: A multicenter retrospective cohort study. Endoscopy, 47(9), 775-783. https://doi.org/10.1055/s-0034-1391844

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms : A multicenter retrospective cohort study. / Tsujii, Yoshiki; Nishida, Tsutomu; Nishiyama, Osamu; Yamamoto, Katsumi; Kawai, Naoki; Yamaguchi, Shinjiro; Yamada, Takuya; Yoshio, Toshiyuki; Kitamura, Shinji; Nakamura, Takeshi; Nishihara, Akihiro; Ogiyama, Hideharu; Nakahara, Masanori; Komori, Masato; Kato, Motohiko; Hayashi, Yoshito; Shinzaki, Shinichiro; Iijima, Hideki; Michida, Tomoki; Tsujii, Masahiko; Takehara, Tetsuo.

In: Endoscopy, Vol. 47, No. 9, 01.09.2015, p. 775-783.

Research output: Contribution to journalArticle

Tsujii, Y, Nishida, T, Nishiyama, O, Yamamoto, K, Kawai, N, Yamaguchi, S, Yamada, T, Yoshio, T, Kitamura, S, Nakamura, T, Nishihara, A, Ogiyama, H, Nakahara, M, Komori, M, Kato, M, Hayashi, Y, Shinzaki, S, Iijima, H, Michida, T, Tsujii, M & Takehara, T 2015, 'Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: A multicenter retrospective cohort study', Endoscopy, vol. 47, no. 9, pp. 775-783. https://doi.org/10.1055/s-0034-1391844
Tsujii, Yoshiki ; Nishida, Tsutomu ; Nishiyama, Osamu ; Yamamoto, Katsumi ; Kawai, Naoki ; Yamaguchi, Shinjiro ; Yamada, Takuya ; Yoshio, Toshiyuki ; Kitamura, Shinji ; Nakamura, Takeshi ; Nishihara, Akihiro ; Ogiyama, Hideharu ; Nakahara, Masanori ; Komori, Masato ; Kato, Motohiko ; Hayashi, Yoshito ; Shinzaki, Shinichiro ; Iijima, Hideki ; Michida, Tomoki ; Tsujii, Masahiko ; Takehara, Tetsuo. / Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms : A multicenter retrospective cohort study. In: Endoscopy. 2015 ; Vol. 47, No. 9. pp. 775-783.
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T2 - A multicenter retrospective cohort study

AU - Tsujii, Yoshiki

AU - Nishida, Tsutomu

AU - Nishiyama, Osamu

AU - Yamamoto, Katsumi

AU - Kawai, Naoki

AU - Yamaguchi, Shinjiro

AU - Yamada, Takuya

AU - Yoshio, Toshiyuki

AU - Kitamura, Shinji

AU - Nakamura, Takeshi

AU - Nishihara, Akihiro

AU - Ogiyama, Hideharu

AU - Nakahara, Masanori

AU - Komori, Masato

AU - Kato, Motohiko

AU - Hayashi, Yoshito

AU - Shinzaki, Shinichiro

AU - Iijima, Hideki

AU - Michida, Tomoki

AU - Tsujii, Masahiko

AU - Takehara, Tetsuo

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background and study aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals. Patients and methods: Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed. Results: The median tumor size was 18mm (range 2-85mm). The median procedure time was 90 minutes (range 12-450 minutes). The en bloc resection and complete resection rates were 96.7% (95% confidence interval [CI] 94.4%-98.1%) and 84.5% (95%CI 80.5%-87.8%), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2% (95%CI 3.3%-7.9%), 1.6% (95%CI 0.7%-3.5%), 0%, and 7.1% (95%CI 4.9%-10.2%) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR]=4.04; P<0.01) and low volume institutions (OR=3.03; P =0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR=32.3; P<0.01). The procedure times significantly decreased in the later period of the study (P<0.01). Follow-up data (median 35 months; range 4-98 months) showed significant differences in overall survival (P=0.03) and recurrence-free survival (P<0.01) rates between patients with curative and noncurative resections. Conclusions: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

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