Western outcomes of circumferential endoscopic submucosal dissection for early esophageal squamous cell carcinoma

Rodríguez de Santiago, Enrique van Tilburg, Laurelle Deprez, Pierre H. [UCL] Pioche, Mathieu Pouw, Roos E. Bourke, Michael J. Seewald, Stefan Weusten, BasLAM. Jacques, Jeremie Leblanc, Sara Barreiro, Pedro Lemmers, Arnaud Parra-Blanco, Adolfo Küttner-Magalhães, Ricardo Libânio, Diogo Messmann, Helmut Albéniz, Eduardo Kaminski, Michal F. Mohammed, Noor Zabala, Felipe Ramos Herreros-de-Tejada, Alberto Koecklin, Hugo Uchima Wallenhorst, Timothée Santos-Antunes, João Cunha Neves, João A. Koch, Arjun D. Ayari, Myriam Duran, Rodrigo Garces Ponchon, Thierry Rivory, Jérôme Bergman, Jacques J.G. H.M. Verheij, Eva P.D. Gupta, Sunil Groth, Stefan Lepilliez, Vincent Franco, Ana Rita Belkhir, Sanaa White, Jonathan Ebigbo, Alanna Probst, Andreas Legros, Romain Pilonis, Nastazja Dagny de Frutos, Diego González, Raquel Muñoz Dinis-Ribeiro, Mario Dano, Helene Deswysen, Yannick Moll, Frédéric Albouys, Jérémie Dahan, Martin Arisha, Muhammad Abu Maggio, Ewerton Marques Yakovenko, Vladyslav Lepilliez, Vincent Félix, Catarina Fraile, Miguel Villarejo, Guiomar Moral Coutada, Andreia Nagl, Sandra Moreno, Eloisa Romero Winters, Conchubhair Santiago, José Torrego, Pedro Peñas, Beatriz Parejo, Sofia et al.[show all]

Background and aims: Circumferential endoscopic submucosal dissection (cESD) in the esophagus has been reported to be feasible in small Eastern case series. We assessed the outcomes of cESD in the treatment of early esophageal squamous cell carcinoma (ESCC) in Western countries. Methods: We conducted an international study at 25 referral centers in Europe and Australia using prospective databases. We included all patients with ESCC treated with cESD before November 2022. Our main outcomes were curative resection according to European guidelines and adverse events. Results: A total of 171 cESDs were performed on 165 patients. En bloc and R0 resections rates were 98.2% (95% CI 95.0%-99.4%) and 69.6% (95% CI 62.3%-76.0%), respectively. Curative resection was achieved in 49.1% (95% CI 41.7%-56.6%) of the lesions. The most common reason for non-curative resection was deep submucosal invasion (21.6%). The risk of stricture requiring six or more dilations or additional techniques (incisional therapy/stent) was high (71%), despite the use of prophylactic measures in 93% of the procedures. The rates of intraprocedural perforation, delayed bleeding and adverse cardiorespiratory events were 4.1%, 0.6% and 4.7%, respectively. Two patients died (1.2%) from a cESD-related adverse event. Overall and disease-free survival rates at 2 years were 91% and 79%. Conclusions: In Western referral centers, cESD for ESCC is curative in approximately half of the lesions. It can be considered a feasible treatment in selected patients. Our results suggest the need to improve patient selection and to develop more effective therapies to prevent esophageal strictures.