title: A European case series of endoscopic submucosal dissection for gastric superficial lesions.
abstract: BACKGROUND
  EMR is an accepted method for resection of superficial lesions in the GI tract. However, because it leads, not unusually, to piecemeal resection, histopathologic interpretation problems and an increased risk of recurrence are noticeable. Endoscopic submucosal dissection (ESD) allows a higher rate of en bloc resection, with low recurrence. Nevertheless, this technique, namely in the upper-GI tract, has rarely been described in Western countries, probably because of the rarity of gastric cancer in most countries.
  
  
  OBJECTIVE
  To describe the efficacy and safety of ESD for gastric superficial lesions in a European country.
  
  
  METHODS
  Consecutive case-series report.
  
  
  METHODS
  A tertiary specialized center.
  
  
  METHODS
  Nineteen patients with gastric superficial lesions (15-30 mm), with high-grade (n = 15) or low-grade (n = 4) noninvasive epithelial neoplasias, in the antrum (n = 12), incisura angularis (n = 2), body (n = 3), and cardia (n = 2).
  
  
  METHODS
  ESD with the patient under general anesthesia in the endoscopic room (40-300 minutes) by using an insulated-tip-knife.
  
  
  METHODS
  Complete (R0) and en bloc resection, and complications.
  
  
  RESULTS
  ESD was achieved in all cases, with 89% R0 resection and 79% en bloc resection rates observed. Major bleeding was reported in 1 case (5%); there were no cases of perforation. With a median follow-up of 10 months, a single recurrence (5%) was observed.
  
  
  CONCLUSIONS
  A small series at a single center, with a short median follow-up time.
  
  
  CONCLUSIONS
  We report the feasibility and effectiveness of gastric ESD in Europe. A further description of a Western series is expected, and guidelines for its dissemination are desirable to define the role of this technique in Western countries.
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Mario
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.forename: Pedro
authors.initials: P
authors.lastname: Pimentel-Nunes
authors.forename: Mariana
authors.initials: M
authors.lastname: Afonso
authors.forename: Natalia
authors.initials: N
authors.lastname: Costa
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopes
authors.forename: Luis
authors.initials: L
authors.lastname: Moreira-Dias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome