ИСТИНА

The speaker is Fedorov ED. Aim: to analyze the immediate outcomes of EMR and ESD for superficial epithelial gastric lesions (SEGL) from the point of view of their safety. Materials&Methods: a total of 137 pts., m - 35(25,5%), f – 102 (74,5%), (mean age M±s 61,7±14,2 years) with 148 SEGL have been treated with EMR (121) and ESD (27) between I.2004 and X.2013. The size of the lesions varied from 3 to 40 mm. The lesions were located in the antrum (57,4%, 85/148), corpus (24,3%, 36/148), cardia (14,2%, 21/148), esophageal-gastric junction (4,1%, 6/148). The methods of EMR were strip-off biopsy, lift and cut, EMR cap technique. The ESD was performed with IT-knife, hook knife, flex knife and triangle knife. The results: The median time of ESD and EMR was 82,5 (quartiles 60-120) and 40 (quartiles 30-60) min (p<0,001) respectively. From 148 lesions 146 were completely removed through the endoscope. In 2 cases the lesions were not removed: technical problems during EMR - 1; intraoperative bleeding during ESD - 1. Complications occurred in 6 cases of EMR (5%, 6/121; 95% CI 0,3 – 9,7): 1 intraoperative and 5 postoperative bleedings from the site of the resection, all of them were stopped endoscopically. After ESD three (11,1%, 3/27; 95% CI 0 – 27; p=0,16) complications were recorded: 1 intraoperative bleeding in a patient with coagulopathy and recurrent pulmonary embolism – laparotomy, partial gastric resection, lethal outcome after 7 days from massive tromboembolia; 1 intraoperative bleeding (endohaemostasis) and 1 perforation on 2 day after ESD in the coagulation zone (laparotomy, sectoral resection; recovery). In general relative en bloc resection rate was 78,1% (114/146; 95% CI 70,8–85,4): EMR–75,8% (91/120), ESD–88,5% (23/26), p=0,20. En bloc resection rate of conventional EMR was significantly higher for lesions measuring less than 15 mm, then more large: 83,9% (78/93, 95% CI 75,4–92,4) and 48,1% (13/27, 95% CI 25,7–70,5; p<0,001). In similar settings for ESD the difference was not significant: relative en bloc resection rate for SEGL less than 15 mm was 100% (11/11 95% CI 71,5–100), and more than 15 mm – 80% (12/15, 95% CI 51,9–95,7; р=0,24). ESD was more effective than EMR in en bloc resection for SEGL more than 15 mm in size (80% and 48,1%), but the difference is not significant (р=0,06). Conclusions: ESD has advantages over conventional EMR in en bloc resection for SEGL measuring more than 15 mm. We did not found any differences between ESD and EMR in the rate of post-operative bleedings, but the absolute quantity of intraoperative bleeding, perforation and overall number of complications tend to be higher after ESD, while statistically - with these amounts of cases - the difference was not proven.