title: Treatment of gastric epithelial tumours by endoscopic submucosal dissection using an insulated-tip diathermic knife.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre- and early malignant gastrointestinal lesions.
  
  
  OBJECTIVE
  To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated-tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens.
  
  
  METHODS
  One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated.
  
  
  RESULTS
  The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low-grade dysplasia and six were found to be high-grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery.
  
  
  CONCLUSIONS
  ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and⁄or perforation. Differences in the interpretation of histological results among different pathologists and⁄or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies.
authors.affiliation: Department of Gastroenterology, The First People's Hospital of Nantong, Jiangsu, People's Republic of China. xlh1118@yahoo.com.cn
authors.forename: Li Hua
authors.initials: LH
authors.lastname: Xu
authors.forename: Qian
authors.initials: Q
authors.lastname: Jun Bo
authors.forename: Gu
authors.initials: G
authors.lastname: Liu Gen
authors.forename: Lu
authors.initials: L
authors.lastname: Fei
authors.forename: Wang
authors.initials: W
authors.lastname: Ya Min
authors.forename: Li
authors.initials: L
authors.lastname: Yu Ming
authors.forename: Lu
authors.initials: L
authors.lastname: Hua Sheng
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000465:Algorithms; D004210:Dissection / Q000295:instrumentation / Q000379:methods; D004564:Electrocoagulation / Q000295:instrumentation*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*