Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria.
OBJECTIVE
Endoscopic submucosal dissection (ESD) can remove early gastric cancer (EGC) en bloc. We sought to assess the feasibility and efficacy of ESD and the clinical outcomes based on the indication criteria.


METHODS
551 patients with 589 EGC lesions were divided into the guideline criteria group (elevated lesion < or =20 mm in diameter and depressed lesion < or =10 mm without ulceration) and the expanded criteria group (mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings < or =3 cm in diameter; and minute submucosal invasive cancer < or =3 cm in size).


RESULTS
En bloc, complete and curative resection were achieved in 98.6 and 93.0, 95.1 and 88.5, and 97.1 and 91.1%, for the guideline and expanded criteria lesions, respectively; the differences between the 2 groups were significant for each. The expanded criteria lesions were at significantly higher risk of ESD-associated bleeding and perforation. Overall survival was adequate irrespective of the indications, and the disease-specific survival rates were 100% in both.


CONCLUSIONS
ESD for EGCs that met the expanded criteria was acceptable, though the resection rates and safety were decreased compared to those for the guideline criteria lesions.
Yamaguchi
Naoyuki
N
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Second Department of Internal Medicine, Nagasaki, Japan.
Isomoto
Hajime
H
Fukuda
Eiichiro
E
Ikeda
Kohki
K
Nishiyama
Hitoshi
H
Akiyama
Motohisa
M
Ozawa
Eisuke
E
Ohnita
Ken
K
Hayashi
Tomayoshi
T
Nakao
Kazuhiko
K
Kohno
Shigeru
S
Shikuwa
Saburo
S
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate