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THE LARGEST SINGLE-CENTER EXPERIENCE IN ENDOSCOPIC SUBMUCOSAL DISSECTION IN EGYPT: CLINICAL OUTCOMES AND SAFETY
Ahmad a. Madkour
*6, Amr El Fouly
6, Butros Fakhoury
5, Ahmed Gammal
2, Ahmed Tawansy
6, Amr Abdelazim
6, Ahmed Shuman
1, Ayman Aboushmeila
6, Hazem Abosheaishaa
4,31Damanhour oncology center, Damanhour, Egypt; 2Dar El Shefa Hospital, Cairo, Cairo, Egypt; 3GI Research Club, American Society for Inclusion , Diversity and Equity in Health care, Lewes, DE; 4Icahn School of Medicine at Mount Sinai, New York, NY; 5Virginia Commonwealth University, Richmond, VA; 6Helwan University Faculty of Medicine, Cairo, Egypt
Background:
Endoscopic Submucosal Dissection (ESD) enables en-bloc resection of gastrointestinal lesions, offering curative potential, particularly in early cancers. This study presents outcomes from the largest single-center ESD experience in Egypt.
Methods:
A retrospective review of 190 patients who underwent ESD was conducted. Patient demographics, lesion characteristics, procedural techniques, outcomes, and complications were analyzed.
Results:
Among 190 cases, the median age of patients was 55 years (IQR: 43–66), with 50% female. The main presenting symptoms included gastrointestinal bleeding (32.1%), anemia (25.3%), and screening (17.9%). Lesions were distributed as follows: anorectal region (34.2%), proximal colon (23.7%), stomach (20.5%), distal colon (12.6%), and esophagus (7.9%), with one lesion in the duodenum and one at the Colo-ileal anastomosis.
Histopathological findings included Tubular Villous Adenoma with High-Grade Dysplasia (25.3%), Intramucosal Carcinoma (17.9%), Adenocarcinoma (AC) (10%), Neuroendocrine Tumors (6.8%), and hyperplastic polyps (5.8%). The median depth of adenocarcinoma invasion was 350 µg (IQR: 150–1000), with lymphovascular invasion in 15.1% of the intramucosal and AC. En-bloc resection was achieved in 95.8%, with R0 resection in 94.7%. The median procedure time was 100 minutes (IQR: 50–145). Complications included intra-procedural perforation in one patient which needed urgent surgical intervention, and delayed perforation was noted in two patients, delayed bleeding (9.5%), pain (7.4%), and stricture formation (3.7%). At a median follow-up of 6 months (IQR: 4–12), local recurrence was observed in 0.5% of cases.
Conclusion:
ESD demonstrates high en-bloc and R0 resection rates with a favorable safety profile. These findings highlight ESD as an effective technique in Egypt, potentially improving early cancer management in the region.
Figure 1: shows the median age
Figure 2: R0 resection rates per location
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