Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife.
OBJECTIVE
To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with over 20 mm early gastric cancer (EGC).


METHODS
A total of 112 patients with over 10 mm EGC were treated with IT-ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 5 year period from January 2002 to December 2006, including 40 patients with over 20 mm EGC. We compared patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, perforation rate between patients with over 20 mm EGC [over 20 mm group (21-40 mm)] and the remaining patients (under 20 mm group).


RESULTS
We found no significant difference in the rate of underlying cardiopulmonary disease (over 20 mm group vs under 20 mm group, 5.0% vs 5.6%), one-piece resection rate (95% vs 96%), CR rate (85% vs 89%), operation time (72.3 min vs 66.5 min), bleeding rate (5% vs 4.2%), and perforation rate (0% vs 1.4%) between the 2 groups. Three patients in each group had submucosal invasion and two in each groups underwent additional surgery.


CONCLUSIONS
There was no significant difference in the outcome resulting from IT-ESD between the 2 groups. Our study proves that IT-ESD is a feasible treatment for patients with over 20 mm mucosal gastric cancer although the long-term outcome should be evaluated in the future.
Second Department of Internal Medicine, Sumitomo Besshi Hospital, 3-1 Ohji-cho, Niihama 792-8543, Japan. shoji_hirasaki@ni.sbh.gr.jp
Shoji
S
Hirasaki
Hiromitsu
H
Kanzaki
Minoru
M
Matsubara
Kohei
K
Fujita
Fusao
F
Ikeda
Hideaki
H
Taniguchi
Eiichiro
E
Yumoto
Seiyuu
S
Suzuki
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D004564:Electrocoagulation / Q000295:instrumentation*; D004724:Endoscopy / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004867:Equipment Design; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome
D000925:Anticoagulants