Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection.
BACKGROUND
Endoscopic mucosal resection is an established method for treating intramucosal gastric neoplasms. Conventional endoscopic mucosal resection has predominantly been performed using strip biopsy, but local recurrence sometimes occurs due to such piecemeal resection. Endoscopic submucosal dissection has recently been performed in Japan using new devices such as an insulation-tip diathermic knife. The efficacy and problems associated with endoscopic submucosal dissection were evaluated by comparison with conventional endoscopic mucosal resection.


METHODS
Treatment consisted of conventional endoscopic mucosal resection for 48 lesions from January 1999 to October 2002, and endoscopic submucosal dissection for 59 lesions from November 2002 to June 2005. Endoscopic submucosal dissection was performed using an insulation-tip diathermic knife and flex and hook knives, as appropriate.


RESULTS
For lesions >or=11 mm in size, en bloc resection rates were significantly higher with endoscopic submucosal dissection than with conventional endoscopic mucosal resection, but treatment time was significantly longer. En bloc resection rates were higher with endoscopic submucosal dissection than with conventional endoscopic mucosal resection in all areas. Treatment of lesions in the upper one-third of the stomach took a long time using endoscopic submucosal dissection, and intraoperative bleeding was frequent. However, en bloc resection rates and intraoperative bleeding with endoscopic submucosal dissection were improved using various knives.


CONCLUSIONS
Endoscopic submucosal dissection can take a long time, but is superior to conventional endoscopic mucosal resection for treating intramucosal gastric neoplasms.
Shimura
Takaya
T
Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Sasaki
Makoto
M
Kataoka
Hiromi
H
Tanida
Satoshi
S
Oshima
Tadayuki
T
Ogasawara
Naotaka
N
Wada
Tsuneya
T
Kubota
Eiji
E
Yamada
Tomonori
T
Mori
Yoshinori
Y
Fujita
Fumitaka
F
Nakao
Haruhisa
H
Ohara
Hirotaka
H
Inukai
Masami
M
Kasugai
Kunio
K
Joh
Takashi
T
D000368:Aged; D016009:Chi-Square Distribution; D004210:Dissection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome