A Tertiary Centre Experience of Endoscopic Submucosal Dissection(ESD) in Singapore

Aim: A retrospective review of a single centre's experience in ESD for the treatment of gastrointestinal neoplasms.Methods: Patients' records from all ESD cases performed in our institution were selected between May 2011 and January 2014. All lesions identified were further assessed by imaged enhanced endoscopy with magnification prior to ESD.Results: A total of 22 ESD cases were performed (Mean age 66 years, Range 41-81years). The site of lesions treated with ESD were the oesophagus(n=1), stomach(n=7), colon(n=14). The median size of lesions was 25.5mm (range 10-65mm) with 73% en bloc resection rate. Histopathology reported 45.5% of high grade dysplasia (stomach n=4, colon n=6) and 13.6% of cancer (stomach n=2, rectum n=1) with complete R0 resection rate of 70%. The median duration of ESD was 177 minutes (range 60-429 minutes). Minor bleeding seen in 5 cases and perforation in 3 cases(1 had surgery and 2 managed with clips). Only 1 case of recurrence of large rectal serrated adenoma polyp was seen at 34 months post ESD. Conclusion: From our early experience in performing ESD, our data is consistent with other centres outside of Japan. ESD is more commonly performed in colorectal lesions. Selection of appropriate cases is important to achieve complete R0 resection rate.