Curva de aprendizaje en disección endoscópica de la submucosa en un hospital universitario latinoamericano / Learning curve in the endoscopic submucosal dissection at a Latin American university hospital

RESUMEN

Introduction: The endoscopic submucosal dissection (ESD) is a technique used in the treatment of early gastric cancer that was developed in Japan in the early 90's. When compared with mucosectomy it shows clear benefits, as lower local recurrence with the resection of lesions greater than 2 cm, yet with larger number of complications, especially bleeding and perforation. There is little experience with ESD in the West, because of the low incidence of early gastric cancer and the lack of screening programs; ESD reports are scarce in Colombia. Objective: To report the experience with the endoscopic dissection of the gastric submucosa in the period between March 2012 and January 2014 at Hospital de San José, Bogotá, Colombia. Methods: ESD was performed in eight patients (four men and four women) that fulfilled the Vienna criteria for this procedure. Results: Eight ESD were performed, three in the body and five in the antrum, with a mean size of 3.4 cm; complications included bleeding in one patient and perforation in one patient. En bloc resection was achieved in all eight cases with R0 (margins free of tumor) in seven patients. Conclusion: Gastric ESD is a complex technique and infrequent technique in our evironment. The procedure was performed in a safe manner with acceptable complication rates and achieving en bloc resection in all patients.

ABSTRACT

Introduction: The endoscopic submucosal dissection (ESD) is a technique used in the treatment of early gastric cancer that was developed in Japan in the early 90's. When compared with mucosectomy it shows clear benefits, as lower local recurrence with the resection of lesions greater than 2 cm, yet with larger number of complications, especially bleeding and perforation. There is little experience with ESD in the West, because of the low incidence of early gastric cancer and the lack of screening programs; ESD reports are scarce in Colombia. Objective: To report the experience with the endoscopic dissection of the gastric submucosa in the period between March 2012 and January 2014 at Hospital de San José, Bogotá, Colombia. Methods: ESD was performed in eight patients (four men and four women) that fulfilled the Vienna criteria for this procedure. Results: Eight ESD were performed, three in the body and five in the antrum, with a mean size of 3.4 cm; complications included bleeding in one patient and perforation in one patient. En bloc resection was achieved in all eight cases with R0 (margins free of tumor) in seven patients. Conclusion: Gastric ESD is a complex technique and infrequent technique in our evironment. The procedure was performed in a safe manner with acceptable complication rates and achieving en bloc resection in all patients.