Fine-tuning the criteria for strip biopsy and endoscopic submucosal dissection improves the outcome of early gastric carcinoma treatment.
OBJECTIVE
Strip biopsy and endoscopic submucosal dissection (ESD) have been developed as a local treatment for early gastric cancer (EGC). However, the lesion criteria for the use of ESD, rather than strip biopsy, remain to be elucidated.


METHODS
On the basis of reviews of literature and our observations concerning the outcome of strip biopsy, we set the criteria for selecting strip biopsy and ESD as follows. The indications for strip biopsy were lesions less than 10 mm in size and located in the anterior wall or greater curvature of the lower and middle stomach. ESD was indicated for all other lesions. The validity of the criteria was then analyzed prospectively in 156 patients. The rate of en bloc R0 resection and local recurrence were evaluated.


RESULTS
Subsequently, 156 lesions were divided according to the criteria and were endoscopically resected by strip biopsy (n = 13) or ESD (n = 143). The en bloc R0 resection rates for the whole group and the strip biopsy and ESD groups was 93.5% (146/156), 92.3% (12/13), and 93.7% (134/143), respectively. None of the patients had suffered from local recurrence in either the strip biopsy or ESD groups.


CONCLUSIONS
The validity of our criteria for selecting strip biopsy and ESD was verified. Our criteria exploit the advantages of both procedures and obtain better endoscopic therapy outcomes for EGC.
Nishikawa
Jun
J
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan. junnis@yamaguchi-u.ac.jp
Satake
Masaaki
M
Hamabe
Kouichi
K
Fukagawa
Yuki
Y
Shirai
Yasuyuki
Y
Kiyotoki
Shu
S
Saito
Mari
M
Okamoto
Takeshi
T
Sakaida
Isao
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D004210:Dissection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome