Endoscopic Submucosal Dissection in Iran: Preliminary Results

Endoscopic submucosal dissection (ESD) is a novel technique for removal of early mucosal neoplasms of gastrointestinal tract. While it has been widely used in Japan and eastern Asian countries, there have been no data available from Iran. Here we report our experience with this method in a single, private, non-tertiary care, and non-referral hospital in Iran.
Demographics, outcomes, and complications of ESD of six lesions in six patients performed at a single center during 2013-2016 were retrospectively evaluated.
The mean (range) age of the patients was 60.5 (40 - 71) years. Of them three had gastric lesions and three had rectal lesions. Two gastric lesions were HGD (High Grade Dysplasia) and one was intramucosal carcinoma. Rectal lesions were villous adenoma in one case and two T1 adenocarcinomas in two other cases. The mean (range) size of the lesions size was 3.1 cm (2.5-8 cm). Complete removal was achieved in all the patients both endoscopically and histopathologically. Microscopic perforation occurred in one case, which was managed conservatively without a need for surgical intervention. No significant late bleeding was observed. No surgery was needed either for completion of removal or control of complications. During mean follow-up of 20 months no recurrence occurred.
Our first experience with ESD shows its high rate of effectiveness with acceptable complication rate and success rate. Proper patient selection and use of standard techniques and instruments are required to produce clinically acceptable outcomes for patients in need of this method to cure their early mucosal neoplasia.