Hospital Authority audit of the outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong

Hong Kong Med J. 2015 Jun;21(3):224-31. doi: 10.12809/hkmj144380. Epub 2015 May 22.

Abstract

Objectives: To review the short-term outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong.

Design: Historical cohort study.

Setting: All Hospital Authority hospitals in Hong Kong.

Patients: This was a multicentre retrospective study of all patients who underwent endoscopic resection of superficial upper gastro-intestinal lesions between January 2010 and June 2013 in all government-funded hospitals in Hong Kong.

Main outcome measures: Indication of the procedures, peri-procedural and procedural parameters, oncological outcomes, morbidity, and mortality.

Results: During the study period, 187 lesions in 168 patients were resected. Endoscopic mucosal resection was performed in 34 (18.2%) lesions and endoscopic submucosal dissection in 153 (81.8%) lesions. The mean size of the lesions was 2.6 (standard deviation, 1.8) cm. The 30-day morbidity rate was 14.4%, and perforations and severe bleeding occurred in 4.3% and 3.2% of the patients, respectively. Among patients who had dysplasia or carcinoma, R0 resection was achieved in 78% and the piecemeal resection rate was 11.8%. Lateral margin involvement was 14% and vertical margin involvement was 8%. Local recurrence occurred in 9% of patients and 15% had residual disease. The 2-year overall survival rate and disease-specific survival rate was 90.6% and 100%, respectively.

Conclusion: Endoscopic mucosal resection and endoscopic submucosal dissection were introduced in low-to-moderate-volume hospitals with acceptable morbidity rates. The short-term survival was excellent. However, other oncological outcomes were higher than those observed in high-volume centres and more secondary procedures were required.

Keywords: Endoscopy; Gastrointestinal neoplasms; Treatment outcome.

Publication types

  • Multicenter Study

MeSH terms

  • Adenoma / pathology
  • Adenoma / surgery*
  • Aged
  • Blood Loss, Surgical
  • Carcinoma / pathology
  • Carcinoma / surgery*
  • Dissection / adverse effects
  • Duodenal Neoplasms / pathology
  • Duodenal Neoplasms / surgery*
  • Endoscopy, Gastrointestinal
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Female
  • Gastric Mucosa / surgery
  • Hong Kong
  • Humans
  • Intestinal Mucosa / surgery
  • Intestinal Perforation / etiology*
  • Male
  • Medical Audit
  • Middle Aged
  • Neoplasm, Residual
  • Postoperative Hemorrhage / etiology*
  • Retrospective Studies
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Survival Rate
  • Treatment Outcome