title: A single-center experience of endoscopic submucosal dissection performed in a Western setting.
abstract: BACKGROUND
  Compared with the piecemeal resection associated with endoscopic mucosal resection, endoscopic submucosal dissection (ESD) enables en bloc resection of larger lesions, allows for more accurate histological assessments, and has reduced recurrence rates. ESD is not widely performed in Western countries given increased technical difficulty, high complication rates, and long procedure times.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of ESD in a single center in the USA.
  
  
  METHODS
  A retrospective study on a prospectively collected database identified cases in which a single operator (IW) performed ESD at a tertiary referral center. Twenty cases were identified, nine in the upper digestive tract (four esophagus and five stomach) and 11 in the lower digestive tract (nine rectal and two sigmoid colon). Data regarding lesion location, pathology, method of ESD (composition/volume of lifting injection and resection method), post-procedure complications, and margin involvement were collected.
  
  
  RESULTS
  En bloc resection was obtained in 14/20 patients (70 %). The average procedure time was 202 min in the esophagus, 148 min in the stomach, and 106 min for lower lesions. A major complication (perforation) occurred in 1/20 cases (5 %). Complete resection was obtained in 14/20 (70 %). R0 resection was obtained in 16/20 (80 %) cases.
  
  
  CONCLUSIONS
  The complication, en bloc resection, and complete resection rates of this study are similar to those found in large studies on ESD performed in Eastern settings. ESD is safe and efficacious for en bloc resections of pre-malignant and early-invasive lesions, and should be offered to patients with suitable lesions in Western settings.
authors.affiliation: Department of Medicine, Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, 5700 S Maryland Ave. MC 8043, Chicago, IL, 60637, USA, glang@medicine.bsd.uchicago.edu.
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Lang
authors.forename: Vani J A
authors.initials: VJ
authors.lastname: Konda
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002641:Chicago; D003110:Colonic Neoplasms; D016208:Databases, Factual; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
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