Retrospective Cohort Study on the Efficacy and Safety of Endoscopic Submucosal Dissection for Gastrointestinal Lesions: A Single-Center Experience

Abstract

BACKGROUND:

Gastrointestinal (GI) lesions, including precancerous and early-stage cancerous lesions, are a significant global health concern. Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive treatment option, offering complete en bloc resection with lower recurrence rates compared with traditional surgical methods. However, the efficacy and safety of ESD, particularly in diverse clinical settings, require further evaluation. This study aimed to assess the outcomes of ESD for GI lesions in a single-center cohort, focusing on complete resection rates, complications, and recurrence.

METHODS:

A retrospective cohort study was conducted at Ayatollah Rouhani Hospital in Babol, Iran, from 2018 to 2023. The study included 45 patients with GI lesions who underwent ESD, with 39 patients receiving en bloc resection and six undergoing piecemeal resection. Data on patient demographics, lesion characteristics, resection outcomes, and complications were collected. Follow-up endoscopic examinations were performed every 3 to 6 months to monitor for recurrence or residual lesions. Statistical analysis was performed using SPSS software version 26, with descriptive statistics, t tests, and Chi-square tests used to evaluate outcomes.

RESULTS:

The mean age of participants was 61.92 years (±11.19), with a male predominance (57.7%). Lesions were primarily located in the stomach (46.6%), rectum (26.6%), colon (20%), and esophagus (6.6%). The complete resection (R0) rate was 95.1%, with no significant differences based on lesion location. Complications included three cases of perforation (6.6%) and three cases of immediate bleeding (6.6%), all of which were managed endoscopically without surgical intervention. Recurrence occurred in two cases (4.4%), both in lesions larger than 2 cm. En bloc resection demonstrated lower recurrence (2.5%) and perforation rates (5.1%) compared with piecemeal resection (16.7% recurrence, 16.7% perforation).

CONCLUSION:

ESD is a safe and effective technique for the complete en bloc resection of GI lesions, with high success rates and low recurrence. En bloc resection is superior to piecemeal resection, particularly for larger lesions. While complications such as perforation and bleeding are rare, they can be managed endoscopically. These findings support the use of ESD as a viable alternative to surgery, especially for elderly patients or those with surgical contraindications. Further multicenter studies with long-term follow-up are needed to validate these results and optimize ESD techniques globally.