title: Endoscopic submucosal dissection is an effective and safe therapy for early gastric neoplasms: a multicenter feasible study.
abstract: OBJECTIVE
  The technique of endoscopic submucosal dissection (ESD) was introduced to obtain en bloc specimens of large early gastrointestinal neoplasms. The drawback of ESD is its technical difficulty and, consequently, its higher rate of complication. In this multicenter study, we investigated the therapeutic outcomes of ESD in consecutive patients.
  
  
  METHODS
  From January 2002 to December 2008, 485 early gastric neoplasms in 418 patients were consecutively treated by using ESD procedure performed by 6 endoscopists in 4 institutions in Tokyo. Demorgraphics, tumor location, therapeutic outcomes, and complication rates were analyzed.
  
  
  RESULTS
  The rates of en bloc resection, complete en bloc resection, submucosal invasion, and piecemeal resection were 93.6%, 85.4%, 10.9%, and 5.4%, respectively. In multivariate analysis, the en bloc resection rate was independently lower in lesions in upper portion than in lower portion (P<0.01), lower in larger lesions (>30 mm, P<0.05; 20 to 30 mm, P<0.05), and lower in lesions with a scar (P<0.01). Delayed bleeding occurrence was independently high in larger lesions (>30 mm, P<0.01; 20 to 29 mm, P<0.01) than in small lesions (<20 mm). Institution and endoscopists were not risk factors of en bloc resection and complications
  
  
  CONCLUSIONS
  ESD is an effective and safe therapy in the management of early gastric neoplasms when performed by well-trained endoscopists. Endoscopists should recognize the difficulty to perform ESD for en bloc resection of upper lesion, and the risk of delayed bleeding in cases of lesions >2 cm in size.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. sugimot-tky@umin.net
authors.forename: Takafumi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Okamoto
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Mitsuno
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kondo
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ohmae
authors.forename: Hideo
authors.initials: H
authors.lastname: Mizuno
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Isomura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamaji
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007564:Japan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome