title: Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea.
abstract: OBJECTIVE. Although endoscopic treatment for early gastric cancer (EGC) is an accepted therapy in South Korea and Japan, long-term outcomes remain unknown. We evaluated the clinical outcome of endoscopic submucosal dissection (ESD) for gastric dysplasia and EGC. MATERIAL AND METHODS. A total of 402 patients with gastric dysplasia and EGC were treated with ESD at a single hospital from January 2004 to December 2007. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 9-49 months (median 30 months). Resectability (en bloc or piecemeal resection), curability (complete or incomplete), local recurrence, and disease-free survival rates were estimated. RESULTS. There were 107 patients with low-grade dysplasia (LGD), 97 with high-grade dysplasia (HGD) and 198 with EGC. In EGC patients, en bloc resection was achieved in 89.7% (177/198), the complete resection rate was 87.9% (174/198), and the local recurrence rate was 5.1% (10/198). Tumor size >20 mm was significantly associated with local recurrence (odds ratio 6.45; 95% CI 1.20-20.11; p=0.001). There were significant correlations between the incidences of a piecemeal or incomplete resection and that of local recurrence (odds ratio 5.23; 95% CI 1.02-18.34; p=0.001; and odds ratio 6.99; 95% CI 1.22-21.65; p=0.002, respectively). The 3-year cancer-free survival rate was 94.9%. CONCLUSIONS. Curative treatment with successful en bloc resection can reduce the local recurrence of gastric neoplastic lesions after ESD. Clinical outcome may be excellent, although longer follow-up studies are warranted.
authors.affiliation: Department of Internal Medicine, Dong-A Medical Center, University College of Medicine, Busan, South Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Jang
authors.forename: Seok Reyol
authors.initials: SR
authors.lastname: Choi
authors.forename: Waqar
authors.initials: W
authors.lastname: Qureshi
authors.forename: Min Chan
authors.initials: MC
authors.lastname: Kim
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Jeung
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Han
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Noh
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Baek
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Phil Jo
authors.initials: PJ
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018572:Disease-Free Survival; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors