title: The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey.
abstract: BACKGROUND
  Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time.
  
  
  METHODS
  All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period.
  
  
  RESULTS
  Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 (p= 0.004). En bloc resection improved from 77.1% to 91.7% (p< 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p= 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p< 0.0001), with bleeding decreasing from 11.2% to 4.7% (p= 0.01) and perforations from 18.1% to 8.1% (p= 0.002) over time. No procedure-related mortality was recorded.
  
  
  CONCLUSIONS
  In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.
authors.affiliation: Cochin Hospital, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.affiliation: Edouard Herriot Hospital, Lyon, France; Jean Mermoz Hospital, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
authors.affiliation: Sainte Barbe Hospital, Strasbourg, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Coumaros
authors.affiliation: Cochin Hospital, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: Cochin Hospital, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Leblanc
authors.affiliation: Edouard Herriot Hospital, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Jean Mermoz Hospital, Lyon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Fumex
authors.affiliation: Saint Andre Hospital, Bordeaux, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Chabrun
authors.affiliation: Saint Eloi Hospital, Montpellier, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Bauret
authors.affiliation: Georges Pompidou European Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.affiliation: Nantes University Hospital, Nantes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.affiliation: Grenoble University Hospital, Grenoble, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bichard
authors.affiliation: Saint Philibert Hospital, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bulois
authors.affiliation: Henri Mondor Hospital, Creteil, France, and Princess Grace Hospital, Monaco.
authors.forename: Antoine
authors.initials: A
authors.lastname: Charachon
authors.affiliation: Georges Pompidou European Hospital, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rahmi
authors.affiliation: Avignon Hospital, Avignon, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Bellon
authors.affiliation: Nantes University Hospital, Nantes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lerhun
authors.affiliation: Avignon Hospital, Avignon, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arpurt
authors.affiliation: Jean Minjoz Hospital, Besancon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Koch
authors.affiliation: Jean Mermoz Hospital, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Napoleon
authors.affiliation: Croisé Laroche Hospital, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vaillant
authors.affiliation: Cochin Hospital, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Anouk
authors.initials: A
authors.lastname: Esch
authors.affiliation: Cochin Hospital, Paris, France.
authors.forename: Said
authors.initials: S
authors.lastname: Farhat
authors.affiliation: Société Française d'Endoscopie Digestive (SFED), France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Robin
authors.affiliation: Cochin Hospital, Paris, France.
authors.forename: Nadira
authors.initials: N
authors.lastname: Kaddour
authors.affiliation: Cochin Hospital, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
keywords: Endoscopic submucosal dissection; early neoplasm; endoscopic resection; intramucosal cancer