An Italian Single Center Initial Experience with Endoscopic Submucosal Dissection

Background: Endoscopic submucosal dissection (ESD) allows curative, en-bloc removal of superficial malignant or premalignant lesions however in the Western countries, and particularly in Italy, experience with this technique is still limited. Aim: to evaluate the safety and the feasibility of ESD at a single Italian endoscopic center.Patients: Twelve unselected consecutive patients (6 women; median age 72.5 years; range, 65-79 years) underwent ESD at our institution from November 2011 to December 2013. Initially 9 gastric and then 3 rectal lesions were resected, according to a stepwise training protocol. Inclusion criteria followed the extended Gotoda criteria for the stomach and large (>20 mm) nonpeduncolated lesions for the rectum.Results: The median size of the lesions was 18.5 mm (range, 10-55 mm). The R0 and en-bloc resection rates were 92% (11/12) and 84% (2/12), respectively. The median operating time per square centimeter was 42.8 minutes (range, 13.2-154.5). There were two cases of bleeding (both treated conservatively) and no case of perforation. With a median follow up of 7.5 months (range, 3-24), no recurrence were observed while in two patients two metachronous premalignant lesions of the stomach were diagnosed. Conclusion: ESD for superficial malignant/premalignant lesions of the stomach and rectum is feasible in terms of safety and efficacy when a stepwise training approach is used.