The efficacy of endoscopic submucosal dissection compared with modified endoscopic aspiration mucosectomy by assessing the short-term therapeutic results for differentiated mucosal gastric cancer.
BACKGROUND
We developed a modified method of endoscopic aspiration mucosectomy (m-EAM) which includes the pre-cutting of the peripheral mucosa before aspiration, and which has been employed in this department since 1998. An endoscopic submucosal dissection (ESD), which enables the resection of a larger area of the lesion using newly-developed surgical devices, has also been employed here since March 2003. This study was performed to investigate the efficacy of ESD at the present time by assessing the short-term therapeutic results for the procedure in patients with a preoperative diagnosis of early-stage differentiated gastric mucosal cancer, by tumor diameter, as well as by comparing these results with those obtained previously with m-EAM.


METHODS
The study included 110 patients with a preoperative diagnosis of early-stage differentiated gastric mucosal cancer (57 underwent m-EAM and 53 received ESD). A comparison was made between these two groups regarding the short-term therapeutic response (en bloc resection rate, curability, complications, and days of postoperative hospitalization) by the tumor diameter.


RESULTS
The en bloc resection rate was significantly higher for patients with a tumor measuring 21 mm or larger who underwent ESD in comparison to that for those with a similar tumor size who underwent m-EAM (p<0.05). Complications were reported significantly more frequently in patients treated with ESD for a tumor measuring 11 mm or larger (p<0.05) in comparison those treated with m-EAM. There was no significant difference between the two groups with regard to the curability and the days of postoperative hospitalization.


CONCLUSIONS
This study confirmed the efficacy of the ESD procedure which enables surgeons to perform a more reliable en bloc tumor resection.
Department of Surgery, Tokyo Women's Medical University Medical Center, East Tokyo 116-8567, Japan.
Takao
T
Katsube
Minoru
M
Murayama
Noriyuki
N
Isohata
Shinichi
S
Asaka
Kentaro
K
Yamaguchi
Kotaro
K
Kuhara
Soichi
S
Konno
Takeshi
T
Shimakawa
Yoshihiko
Y
Naritaka
Kenji
K
Ogawa
D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013396:Suction / Q000379:methods