title: Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal.
abstract: OBJECTIVE
  Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal.
  
  
  METHODS
  This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n = 54) or ESD (n = 141) and were followed up for a median of 3.2 years.
  
  
  RESULTS
  Resection was feasible in 97 %, with en bloc and R0 resection rates of 85 % (94 % ESD vs. 61 % EMR; P = 0.001) and 81 % (91 % ESD vs. 54 % EMR; P < 0.001), respectively. The recurrence rate was 7 %, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95 % confidence interval 3.9 - 8.8). The long-term curative resection rate was 86 % after one procedure and 91 % after two procedures. Adverse events were observed in 13 % of cases: 8 % bleeding and 2 % of perforations (EMR = ESD). Surgery was performed in 7 %: 6 % after noncurative endoscopic resection and 1 % due to complications. Metachronous lesion detection rate was 1 % - 1.5 % per patient year. Cancer-specific survival rate was 100 % at follow-up.
  
  
  CONCLUSIONS
  For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries.
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pimentel-Nunes
authors.affiliation: CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mourão
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Veloso
authors.affiliation: Department of Pathology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Luís Pedro
authors.initials: LP
authors.lastname: Afonso
authors.affiliation: Department of Pathology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Jácome
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Moreira-Dias
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Dinis-Ribeiro
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D018365:Neoplasm, Residual; D011174:Portugal; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors