title: Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer.
abstract: BACKGROUND
  In EMR of early gastric cancer (EGC), en bloc resection reduces the risk of residual cancer. Endoscopic submucosal dissection (ESD) now allows en bloc resection of large EGCs.
  
  
  OBJECTIVE
  To retrospectively determine whether ESD is more advantageous than EMR for EGCs.
  
  
  METHODS
  EMR (825 lesions, 711 patients) or ESD (195 lesions, 185 patients) was performed. The en bloc resection rate, histologically complete resection rate, operation time, complications, and local recurrence rate were studied in relation to ulceration.
  
  
  METHODS
  Hiroshima University Hospital.
  
  
  METHODS
  Subjects comprised 896 patients in whom 1020 EGCs were resected endoscopically from 1990 to 2004.
  
  
  RESULTS
  In cases without ulceration, en bloc and histologically complete resection rates were significantly higher with ESD than with EMR, regardless of tumor size. The frequency of ulceration did not differ significantly between groups. Average operation time was significantly longer for ESD than for EMR, regardless of tumor size. Also, regardless of ulceration, the incidence of intraoperative bleeding was significantly higher with ESD (22.6%) than with EMR (7.6%). Delayed bleeding did not differ. In cases with ulceration, the incidence of perforation was significantly higher with ESD (53.8%) than with EMR (2.9%). Local recurrences were treated by incomplete EMR (en bloc, 2.9%; piecemeal, 4.4%). No patient experienced recurrence after ESD.
  
  
  CONCLUSIONS
  ESD increased en bloc and histologically complete resection rates and may reduce the local recurrence rate. Increased operation time and complication risks with ESD in comparison with EMR remain problematic. Special measures are necessary for ESD of ulcerated lesions to reduce the rates of perforation and incomplete resection.
authors.affiliation: Department of Endoscopy, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Iwao
authors.initials: I
authors.lastname: Kaneko
authors.forename: Ritsuo
authors.initials: R
authors.lastname: Mouri
authors.forename: Mayuko
authors.initials: M
authors.lastname: Hirata
authors.forename: Toru
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshihara
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D001706:Biopsy; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome