title: Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer.
abstract: BACKGROUND
  Endoscopic mucosal resection is an established treatment option for early stage gastric cancer. However, several problems with endoscopic mucosal resection remain to be solved, such as appropriate treatment for recurrence and incomplete tumor resection. The outcome for patients undergoing endoscopic aspiration mucosectomy (endoscopic mucosal resection) by a modification of the cap-fitted technique was evaluated retrospectively to determine factors associated with complete resection and tumor recurrence.
  
  
  METHODS
  Endoscopic mucosal resection was performed in 106 patients with early stage gastric cancers up to 20 mm in diameter that were well or moderately differentiated adenocarcinoma. All were superficial lesions without ulceration, distinct signs of submucosal invasion, or a poorly demarcated border. En bloc (tumors <10 mm in diameter) or piecemeal (tumors 10-20 mm in diameter) resection was performed. Follow-up endoscopy was performed at 2, 6, 12, 18, and 24 months and thereafter once per year. Outcome and factors associated with complete resection and tumor recurrence were assessed retrospectively.
  
  
  RESULTS
  Sixty-eight patients (64%) underwent en bloc resection and 38 (36%) piecemeal resection. The mean longest dimension (SD) of the resected lesions was significantly greater after piecemeal resection (12.3 [4.0] mm) than after en bloc resection (7.6 [4.0] mm; p < 0.01). In patients with tumors completely resected, there was no recurrence after either en bloc or piecemeal resection. Six of 8 patients found to have submucosal invasion after endoscopic mucosal resection underwent surgery. Patients with incompletely resected intramucosal lesions underwent additional endoscopic treatment. Cancer recurred in 3 patients (2.8%), all of whom had lesions measuring more than 15 mm in diameter.
  
  
  CONCLUSIONS
  Endoscopic mucosal resection is safe and useful for the management of early stage gastric cancer. Further improvement in outcome requires more accurate preoperative diagnosis and postoperative histopathologic evaluation. Patients with incompletely resected lesions should undergo aggressive additional treatment.
authors.affiliation: Department of Gastroenterology and Pathology, Kitasato, University East Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanabe
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitomi
authors.forename: Hisao
authors.initials: H
authors.lastname: Nakai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Murakami
authors.forename: Shizuka
authors.initials: S
authors.lastname: Nagaba
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.forename: Masahito
authors.initials: M
authors.lastname: Oida
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome