Predictors of Long-term Outcomes of Endoscopic Submucosal Dissection of Early Gastric Neoplasia in the West: A Multicentre Study.

Introduction In this study, we review long-term outcomes of gastric endoscopic submucosal dissection [ESD] in western setting in light of the latest Japanese indication criteria, and examine predictors of outcomes and complications. Methods Data was collected on consecutive patients referred for gastric ESD in four participating centres from 2009 to 2021. Retrospective analysis of data with logistic regression and survival analysis was performed. Results A total of 415 patients were included. Mean age was 71.7 years, 56.4% were males. Absolute indication criteria [2018 guidelines] were fulfilled in 75.3% of patients. Median follow-up was 52 months. Post-resection histology was adenocarcinoma, HGD and LGD in 49.9%, 22.7% and 17.1% respectively. Perforation, early bleeding and delayed bleeding occurred in 2.4%, 4.3% and 3.4% respectively. En-bloc, R0 and recurrence on first endoscopic follow-up were 94.7%, 83.4% and 2.7% respectively. Relative indication [2018 Guidelines] for ESD was associated with R1 outcome [P-value 0.002]. Distal location [P-value 0.002] and increased procedure time [P-value 0.04] were significantly associated with bleeding risk, whereas scarring [P-value 0.009] and increased procedure duration [P-value 0.003] were associated with perforation. Recurrence-free survival at 2 years and 5 years was 94% and 83% respectively. Conclusion This is the largest multicenter western cohort suggesting gastric ESD is safe and effective in the western setting. A quarter of our patients fell outside of the new absolute indications for ESD, suggesting that western practice involves more advanced lesions. We identified the predictors of adverse outcomes in western practice. This should inform future practice and research.