The modern treatment of early gastric cancer: our experience in an Italian cohort.
BACKGROUND
Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors. However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort.


METHODS
Forty-five patients for a total of 48 gastric lesions were enrolled in the study. Thirty-six EMR procedures were performed with the strip biopsy technique using a double-channel endoscope. En bloc resection refers to resection in one piece, while piecemeal refers to resections in which the lesion was removed in multiple fragments. A total of 12 ESD were performed and completed with IT knife. We define as curative treatment lateral and vertical margins of the resected specimens free of cancer and repeat endoscopic finding of no recurrent disease.


RESULTS
Out of 36 EMR procedures, 10 were piecemeal resections (28%), while 26 were en bloc (72%). ESD led to en bloc resection in 11/12 cases (92%). Histological assessment of curability in the EMR group was achieved in 56% of the cases, and in 92% of the ESD group. Mean follow-up period was 31 months (range: 12-71 months). There was no local recurrence or distant metastasis in the curative group patients.


CONCLUSIONS
These results seem to confirm the safety and the clinical efficacy of the ESD procedure in the Western world too.
Catalano
Filippo
F
Department of Emergency Endoscopy, University of Verona OCM, Ospedale Civile Maggiore, Verona, Italy. filippo.catalano@azosp-vr.it
Trecca
Antonello
A
Rodella
Luca
L
Lombardo
Francesco
F
Tomezzoli
Anna
A
Battista
Serena
S
Silano
Marco
M
Gaj
Fabio
F
de Manzoni
Giovanni
G
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015331:Cohort Studies; D004396:Coloring Agents; D004210:Dissection; D042241:Early Diagnosis; D004867:Equipment Design; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007203:Indigo Carmine; D007558:Italy; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*
D004396:Coloring Agents; D007203:Indigo Carmine