Very low rate of residual neoplasia after non-curative endoscopic submucosal dissection: a western single-center experience

Background Short and long outcomes of endoscopic submucosal dissection (ESD) are now well described. However, the outcome of non-curative ESDs is scarcely reported. Objective To describe our experience with non-curative ESDs, assessing the presence of residual lesion in the endoscopic follow-up or surgery. Methods Data of all the patients submitted to ESD between January 2015 and June 2020 in our tertiary Center was prospectively recorded. Among non-curative ESDs, the presence of residual neoplasia after complementary surgical treatment or in the endoscopic follow-up was assessed. Results In that period, a total of 388 ESDs were performed in the esophagus ( n = 13), stomach ( n = 222), colon ( n = 20), rectum ( n = 132), and duodenum ( n = 1). Median follow-up was 30 months (range 4–69 months). ESD was technically successful in 376 lesions (97%). From 325 neoplastic epithelial lesions and 18 neoplastic submucosal tumors, 61 (17.8%) did not fulfill curative criteria entirely. Positive horizontal margins ( n = 28), positive vertical margins ( n = 10) and submucosal invasion >SM1 ( n = 14) were the main causes of non-curative ESD. Among patients with non-curative ESDs, 20 were operated and 33 were already followed-up by endoscopy, and only seven (13%, corresponding to 2% of the total number of successful neoplastic ESDs) had residual neoplasia. Conclusion Our real-life experience showed that the vast majority of non-curative ESD did not actually have residual neoplasia in the follow-up.