Minimally invasive therapies, such as endoscopic submucosal dissection (ESD), are effective for early-stage oesophageal carcinomas, with the goal of achieving curative resection. ESD is technically demanding, associated with a longer procedural time, and carries a higher risk of complications compared to conventional endoscopic mucosal resection (EMR). Therefore, adequate training and accumulation of procedural experience are critical to achieve optimal outcomes.

 The present study aims to determine in how many patients an ESD could be performed en-bloc, with R0 resection, and curatively, and whether a recurrence occurred. It tries to assess the learning curve associated with ESD in the oesophagus by analysing procedural and oncologic outcomes over a nine-year period at a single centre. Special focus is placed on resection quality (en-bloc, R0, and curative resection rates), complication rates (bleeding, stricture formation), and recurrence within 12 months. In addition, the various indications and follow-up treatments as well as risk factors were analysed.

The patient cohort includes 85 patients diagnosed with early-stage oesophageal carcinoma, treated with ESD at Ordensklinikum Linz Barmherzige Schwestern and Elisabethinen between 2014 and 2022. 

The en-bloc resection rate was 92.9%. An R0 resection was achieved in 77.6% of cases, and curative resection was accomplished in 74.1%. The risk of bleeding was 3.5%, and 18.8% of patients developed strictures after ESD. Tumour recurrence occurred in 7.1% of patients during a median follow-up of 29.5 months.  The learning curve was analysed with consecutive patients divided into three time-based groups: Group 1: 2014–2016, Group 2: 2017–2019, Group 3: 2020–2022. The en bloc resection rates were 89.3%, 96.4%, and 93.1%. Tumour-free margins (R0 resection) were achieved in 64.3%, 75.0%, and 93.1%. Curative resection was accomplished in 60.7%, 71.4%, and 89.7%. Treatment-requiring bleeding occurred in 7.1%, 0%, and 3.4%. The most common complication was the development of strictures, which occurred in 28.6%, 17.8%, and 10.3% of patients. Tumour recurrence within 12 months occurred in 7.1% of patients in Group 1 and Group 2, but in none of the patients in Group 3.

Over the years evaluated in this retrospective data analysis, rates of en-bloc resections, R0 resections, and curative resections increased and are comparable to those reported in other studies. The risk of bleeding and strictures also reflects figures found in current literature. However, the recurrence rate was higher compared to current literature.