title: Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study.
abstract: OBJECTIVE
  The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals.
  
  
  METHODS
  Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed.
  
  
  RESULTS
  The median tumor size was 18 mm (range 2 - 85 mm). The median procedure time was 90 minutes (range 12 - 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % - 98.1 %) and 84.5 % (95 %CI 80.5 % - 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % - 7.9 %), 1.6 % (95 %CI 0.7 % - 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % - 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 - 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections.
  
  
  CONCLUSIONS
  Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tsujii
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishiyama
authors.affiliation: Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawai
authors.affiliation: Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoshio
authors.affiliation: Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kitamura
authors.affiliation: Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology, Minoh City Hospital, Minoh, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishihara
authors.affiliation: Department of Gastroenterology, Itami City Hospital, Itami, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Ogiyama
authors.affiliation: Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakahara
authors.affiliation: Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Komori
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Shinzaki
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Iijima
authors.affiliation: Department of Gastroenterology, Osaka Kosei-nenkin Hospital, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Michida
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujii
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004210:Dissection; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome