title: Initial experience of endoscopic submucosal dissection in Brazil to treat early gastric and esophagheal cancer: a multi-institutional analysis.
abstract: OBJECTIVE
  This study aimed to evaluate the feasibility and clinicopathological characteristics of early gastric and esophageal cancers treated with endoscopic submucosal dissection (ESD) at five centers in Brazil.
  
  
  METHODS
  Five centers in Brazil reported their initial experience with ESD. The cases reported had already been collected by each center before pooled analysis.
  
  
  RESULTS
  Were resected 62 gastric lesions; 52(83,8%) of the gastric lesions were well-differentiated adenocarcinoma, 31(50%) from the antrum, 24 (38.7%) type IIa. 51 (82.2%) lesions had en-block resection with three showing lateral margin compromise. Concerning invasion, 25 (40.3%) tumors were M1. Mean tumor diameter was 18.9 mm (range, 0.6-5.0 cm) and mean procedure duration was 119.45 minutes. Gastric perforation occurred in three (4.8%) patients. Mean follow-up duration was 11.3 months, with two local recurrences and one death from pneumonia Seven months after treatment. Of the 16 esophageal lesions resected, 14 (87.4%) were squamous cell carcinoma, 10 (62.5%) were located proximally and 8 (50.0%) type IIa. Mean tumor diameter was 23.8 mm (range, 6-60 mm). Thirteen (81.2%) lesions had en-block resection with five cases of lateral margin compromise. Eight (50.0%) lesions were M1. Mean procedure duration was 78 minutes (range, 20-150 min). Complications included pneumomediastinum in two (12.5%) patients and stenosis in one (6.2%). Mean duration of follow-up was 8.6 months, with no local recurrence despite the presence of lateral margin compromise.
  
  
  CONCLUSIONS
  Different centers in Brazil feasibly perform ESD with a high success rate.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, SP, Brazil. chavesdalton@gmail.com
authors.forename: Dalton Marques
authors.initials: DM
authors.lastname: Chaves
authors.forename: Eduardo Guimarães H
authors.initials: EG
authors.lastname: Moura
authors.forename: Daniela
authors.initials: D
authors.lastname: Milhomem
authors.forename: Vitor N
authors.initials: VN
authors.lastname: Arantes
authors.forename: Kendi
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf
authors.forename: Walton
authors.initials: W
authors.lastname: Albuquerque
authors.forename: Antonio Carlos C
authors.initials: AC
authors.lastname: Conrado
authors.forename: Júlia C
authors.initials: JC
authors.lastname: Araújo
authors.forename: Paula H S
authors.initials: PH
authors.lastname: Uejo
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome