Endoscopic submucosal dissection in 100 lesions with early gastric carcinoma.
OBJECTIVE
ESD is a new diagnostic and treatment technique for early gastric cancer. This study aimed to evaluate the therapeutic effects observed at our department.


METHODS
The subject group included 95 patients with 100 early-stage gastric cancers. According to the Gastric Cancer Treatment Guidelines published by the Japanease Gastric Cancer Association (JGCA) in 2001. Sixty-seven lesions presented a tumor measuring less than 20 mm and were concave (if not flat) without ulceration (specified indication of the guidelines of the Japanese Gastric Cancer Association), and 33 lesions were expanded indications. We then compared one-piece resection rates, en-bloc resection rates (one-piece resection that is lateral- and vertical-stump negative), curative en-bloc resection rates (en-bloc resection that fulfills the following three criteria: 1. differentiated adenocarcinoma; 2. no lymphtic or venous invasion, 3a. intramucosal cancer regardless of tumor size without ulceration, 3b. intramucosal cancer 30 mm in size with ulceration, 3c. minute submucosal cancer 30 mm in size).


RESULTS
Among the specified indications and expanded indications, one-piece resection rates accounted for 97.0% and 75.8%, en-bloc resection rates for 83.6% and 60.6%, and curative en-bloc resection rates for 83.6% and 57.6%. The numbers of accident cases were three (postoperative hemorrhage; n = 1 perforation; n = 2) and four (postoperative hemorrhage; n = 1, perforation; n = 3), respectively.


CONCLUSIONS
These studies indicated higher one-piece resection rates, en-bloc resection rates and curative en-bloc resection rates for lesions based on the guidelines than those based on the expanded guidelines.
Hitomi
Genyo
G
Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.
Watanabe
Hidetaka
H
Tominaga
Keiichi
K
Yoshitake
Naoto
N
Suzuki
Makoto
M
Maeda
Mitsunori
M
Yamagata
Michiko
M
Kanke
Kazunari
K
Nakamura
Tetsuya
T
Masuyama
Hironori
H
Hiraishi
Hideyuki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome