O7 Outcomes from the UK endoscopic submucosal dissection (UK ESD) registry- what have we learnt?

Introduction The practice of endoscopic submucosal dissection (ESD) for treatment of early gastrointestinal neoplasia has been increasing in the West, however, the uptake has been slow due to a long learning curve and higher complication rate. We aim to analyse UK ESD practice through the development of the first UK national ESD registry. Methods The UK ESD registry was established in 2016 with 4 major tertiary referral centres which was extended to 6 centres by 2019. Data on different parameters ranging from patient demographics to procedural details were collected on a national web based electronic platform and analysed. Results A total of 309 ESDs were performed with a completion rate of 99.2%. Standard ESD was performed in 73.5% whereas hybrid ESD was performed in 26.5% cases. The mean lesion size was 38 mm (range 10 – 130 mm). The overall en bloc resection rate was 86.5%, whereas the R0 resection rate was 72.5%. There were 12 (3.8%) cases with complications ( 7 significant bleeds and 5 perforations). Majority of the colorectal lesions showed a resection histology of LGD (71%) with cancer demonstrated in roughly 10% of the lesions, whereas upper GI lesions showed a higher percentage of atleast SM1 invasive cancer (stomach -61% and oesophagus- 67%). The mean duration between procedure and first follow up endoscopy was 212 days, with visible recurrence occurring in 23 cases (7.4%). Further details comparing standard ESD technique and hybrid ESD have been outlined in table 1. Conclusions We therefore conclude that En bloc resection rates were higher in standard ESD, than in hybrid ESD, however, the latter was involved with fewer complications. Recurrence rates were higher in hybrid ESD compared with standard ESD, however, still lower than for EMR with similar complication rates (specially for colorectal lesions). Although associated with a lower en bloc resection rate and greater recurrence than ESD, hybrid ESD could be an attractive learning step for western endoscopists to be fully competent in standard ESD.