title: Indication for endoscopic treatment of ulcerative early gastric cancer according to depth of ulcer and morphological change.
abstract: OBJECTIVE
  This study was conducted to determine the clinicopathologic factors affecting the stage of ulcerative early gastric cancer (EGC), focusing on the relationships between cancer stage and degree of endoscopic ulcer depth and morphologic changes.
  
  
  METHODS
  Medical records of 183 cases of ulcerative EGC who had received endoscopic examination two or more times with a minimum interval of one week, and who underwent either curative surgery or endoscopic treatment were retrospectively reviewed.
  
  
  RESULTS
  Change in ulcer morphology at follow-up endoscopy was observed in 84 cases (45.9%) with improvement and exacerbation of ulcer in 65 (35.5%) and 19 (13.8%) cases, respectively. The presence of type III ulcer (P < 0.01), and endoscopic findings suggesting submucosal cancer invasion (tumorous bank, fusion of converging folds, hardness or decreased flexibility) (P < 0.01), and incomplete ulcer healing (P = 0.036) were independently associated with a higher incidence of submucosal cancer invasion. The incidence of lymph node metastasis was 14.1%, and undifferentiated histology and presence of lymphovascular invasion were significantly associated with a higher incidence of lymph node metastasis (P = 0.018 and P = 0.005, respectively).
  
  
  CONCLUSIONS
  Endoscopic resection with curative intent may be an acceptable option for EGC combined with endoscopic ulcer or ulcer scar, but should be restricted to cases showing significant improvement in the size and depth of ulcer at follow-up endoscopy, and which are not accompanied with deep ulcer more than the thickness of adjacent mucosal surface and prominent surrounding mucosal fold change. In addition, histologic criteria should meet the conditions of differentiated intramucosal cancer without lymphovascular invasion.
authors: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors: Jae Ik
authors: JI
authors: Lee
authors: Ji Hyun
authors: JH
authors: Kim
authors: Jong Han
authors: JH
authors: Kim
authors: Byoung Jin
authors: BJ
authors: Choi
authors: Young Jin
authors: YJ
authors: Song
authors: Sang Bun
authors: SB
authors: Choi
authors: Young Seok
authors: YS
authors: Bae
authors: Sang Heon
authors: SH
authors: Lee
authors: Sam Ryong
authors: SR
authors: Jee
authors: Mi Seon
authors: MS
authors: Kang
authors: Sang Young
authors: SY
authors: Seol
mesh_terms: D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D013276:Stomach Ulcer / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors