Endoscopic submucosal dissection outcomes for gastro-esophageal tumors in low volume units - a multi-center survey from South East Asia

Background: Endoscopic submucosal dissection (ESD) outcomes have traditionally been reported from high volume centers in East Asia. Data from low volume centers in other parts of Asia remain sparse.Methods: A retrospective survey with a structured questionnaire of 5 tertiary centers in 3 countries in South East Asia was conducted.Results: Seven endoscopists from the 5 centers performed a total of 35 cases of ESD in the upper gastrointestinal tract (UGIT) over a 6-year duration. Details of the lesions excised: median size 20mm, morphologically 19 (54.3%) were flat/ depressed and 8 (22.9%) were submucosal, and histologically 27 (77.1%) were neoplastic. Median duration of ESD procedures was 105 minutes, with an en-bloc resection rate of 91.4%. No delayed bleeding, perforation nor mortality in any of the cases. Recurrence rate post ESD was 5.7%. A prolonged ESD duration, was influenced by a larger size of lesion (25mm, p=0.02) but not by factors related to the training experience of endoscopists.Conclusions: ESD in the UGIT is feasible and safe, even in low volume centers in Asia.