title: Efficacy of clinical pathway for the management of mucosal gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Shikoku Cancer Center, Matsuyama.
authors.forename: Shoji
authors.initials: S
authors.lastname: Hirasaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Tanimizu
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Moriwaki
authors.forename: Ichinosuke
authors.initials: I
authors.lastname: Hyodo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Shinji
authors.forename: Norio
authors.initials: N
authors.lastname: Koide
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: 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