IRISH SOCIETY OF GASTROENTEROLOGY

Poster Winners 2020 - Equal Third Prize

Dr. Danny Cheriyan
Beaumont Hospital, Dublin, Ireland

TBA (20W127)

Endoscopic Submucosal Dissection: The First Irish Experience

Author(s)

Dr. Danny Cheriyan

Department(s)/Institutions

Beaumont Hospital, Dublin, Ireland

Introduction

Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique for resection of superficial lesions in the gastrointestinal (GI) tract. The advantage ESD has over endoscopic mucosal resection (EMR) is that it allows for en bloc resection of lesions, regardless of size. Compared to EMR however, ESD takes longer, and has increased rates of complication.

Aims/Background

We describe the first cohort of patients to undergo ESD in a tertiary referral centre in Ireland.

Method

ESD procedures were performed in Beaumont hospital between Sept 2019 and January 2020 by a single endoscopist. An ERBE ‘T-type’ hybrid knife with ERBE VIO 300D electro surgical unit was used. All cases were discussed at multidisciplinary meetings in our centre.

Results

5 patients (3 female) underwent ESD. 3 gastric (LGD, HGD, T1a adenocarcinoma), 1 rectal (TVA with HGD), and 1 ascending colon (TA with HGD) lesions were removed. The ascending colon lesion was removed using a ‘hybrid’ ESD and EMR technique. The median age was 59 years (range 53-84). The median lesion size was 30mm (range 25-32). The median procedure time was 80 min (range 70-120). No immediate or delayed complications were seen. All patients were admitted and discharged the following day. All cases resulted in R0 resection.

Conclusions

ESD is an effective technique in the management of early GI neoplasia, and may reduce the need for surgical intervention. The learning curve is steep and risk of complications higher than EMR, though this early Irish experience is promising. Discussion regarding how to implement this service nationally is required.