Efficacy of clinical pathway for the management of mucosal gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife.
OBJECTIVE
Recently, the cases of early gastric carcinomas which can be treated by endoscopic submucosal dissection (ESD) method have been increasing in our institute. Simple and precise guidelines for treating mucosal gastric carcinoma are necessary for improving the treatment outcome of this disease. In our institute, ESD using an insulated-tip diathermic knife (IT-ESD) was introduced for the treatment of mucosal gastric carcinoma in 1996. The purpose of this study was to evaluate the impact of a clinical pathway and standardize the treatment for mucosal gastric carcinoma treated with IT-ESD.


METHODS
The Clinical Pathway and standardized of treatment for mucosal gastric carcinoma treated with IT-ESD were introduced at our institute in January 2002. We compared the length of hospitalization, total costs, hospital costs, operation time and bleeding rate during the 18 months before and after January 2002.


RESULTS
There was no significant difference in the clinical characteristics of the 20 patients in the control group and the 23 patients in the pathway group. There were 9 and 13 bleeding cases in the respective groups. The mean length of hospitalization, total costs and hospital costs were significantly less for patients in the pathway group. There was no significant difference in the operation time or bleeding rate among the two groups.


CONCLUSIONS
Our clinical pathway and the standardization of treatment for mucosal gastric carcinoma treated with IT-ESD proved effective for treating patients with mucosal gastric carcinoma and for minimizing the length of hospitalization without compromising patient care.
Hirasaki
Shoji
S
Department of Internal Medicine, Shikoku Cancer Center, Matsuyama.
Tanimizu
Masahito
M
Moriwaki
Toshikazu
T
Hyodo
Ichinosuke
I
Shinji
Toshiyuki
T
Koide
Norio
N
Shiratori
Yasushi
Y
D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D019091:Critical Pathways; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments