title: Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions.
abstract: Although the frequency of residual disease and recurrence following endoscopic submucosal dissection (ESD) has markedly decreased, a few cases of residual disease and recurrence following ESD are still observed. The aims of the present study were to clarify the causes of non-curative resection and to investigate the risk factors. A total of 1,123 early gastric neoplasm lesions treated by ESD were investigated. Non-curative resection was defined as histological positivity of the resected margins, vascular invasion or failure ofen blocresection. Cases of non-curative resection were classified as being caused by one of three reasons: Inadequate technique, pre-procedural misdiagnosis or problems in the histological diagnosis. Following classification, the cases of non-curative and curative resection were compared based on a range of patient characteristics: Procedure time, and size, type and location of the lesions. The frequency of non-curative resection was 16% (182 lesions). Non-curative resection occurred due to inadequate technique in 59 cases, pre-procedural misdiagnosis in 88 cases and problems in the histological diagnosis in 35 cases. Multivariate analysis revealed that a large lesion size, long procedure time and inexperienced endoscopist were associated with a significantly higher risk of non-curative resection due to an inadequate technique. Furthermore, it was found that lesions located in the upper area of the stomach and cancer with submucosal invasion were associated with a significantly higher risk of non-curative resection due to pre-procedural misdiagnosis. In conclusion, the present study has shown that the major reasons for non-curative resection are an inadequate technique and pre-procedural misdiagnosis. The risk factors for these problems have been clarified.
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyokawa
authors.affiliation: Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Inaba
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Shizuma
authors.initials: S
authors.lastname: Omote
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Okamoto
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Miyasaka
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Fujita
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.affiliation: Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
authors.forename: Shigenao
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Tamiya
authors.initials: T
authors.lastname: Morikawa
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tomoda
keywords: early gastric neoplasms; endoscopic submucosal dissection; non-curative resection; risk factors