title: Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video).
abstract: BACKGROUND
  Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at major Japanese institutions have reported en bloc resection, en bloc tumor-free margin resection, and curative resection rates of 92.7% to 96.1%, 82.6% to 94.5%, and 73.6% to 85.4%, respectively, with delayed bleeding and perforation rates of 0.6% to 6.0% and 3.6% to 4.7%, respectively. Although ESD is currently an alternative treatment in some countries, particularly in Asia, it remains uncertain whether ESD therapeutic outcomes in Western endoscopy settings can be comparable to those achieved in Japan.
  
  
  OBJECTIVE
  To evaluate the ESD therapeutic outcomes for differentiated early gastric cancer (EGC) in a Western endoscopy setting.
  
  
  METHODS
  Consecutive case series performed by an expertly trained Western endoscopist.
  
  
  METHODS
  Fifty-three patients with 54 lesions.
  
  
  METHODS
  ESD for early gastric cancers (T1) satisfying expanded inclusion criteria.
  
  
  METHODS
  En bloc resection, en bloc tumor-free margin resection, and curative resection rates were 98%, 93%, and 83%, respectively. The delayed bleeding rate was 7%, and the perforation rate was 4%.
  
  
  RESULTS
  The mean patient age was 67 years, and the mean tumor size was 19.8 mm, with 54% of the lesions located in the lesser curvature. The median procedure time was 61 minutes, with ESD procedures 60 minutes or longer associated with submucosal fibrosis (P < .001) and tumor size 25 mm or larger (P = .03). In every ESD procedure, both circumferential incision and submucosal dissection were performed by using a single knife. Two of the 4 delayed bleeding cases required surgery, and all perforations were successfully managed by using endoscopic clips.
  
  
  CONCLUSIONS
  Long-term outcome data are currently unavailable.
  
  
  CONCLUSIONS
  ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western endoscopy setting comparable to those achieved at major Japanese institutions.
authors.affiliation: Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC, Colombia; Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia; Division of Gastroenterology and Endoscopy, Universidad de La Sabana, Bogotá DC, Colombia; Centro de Exploraciones Digestivas, Clínica Universitaria Colombia, Bogotá DC, Colombia.
authors.forename: Fabian
authors.initials: F
authors.lastname: Emura
authors.affiliation: Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC, Colombia.
authors.forename: Juan
authors.initials: J
authors.lastname: Mejía
authors.affiliation: Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia.
authors.forename: Alberto
authors.initials: A
authors.lastname: Donneys
authors.affiliation: Department of Pathology, Universidad Nacional de Colombia, Bogotá DC, Colombia.
authors.forename: Orlando
authors.initials: O
authors.lastname: Ricaurte
authors.affiliation: Centro de Exploraciones Digestivas, Clínica Universitaria Colombia, Bogotá DC, Colombia.
authors.forename: Luis
authors.initials: L
authors.lastname: Sabbagh
authors.affiliation: Department of Internal Medicine, Universidad de La Sabana, Bogotá DC, Colombia.
authors.forename: Luis
authors.initials: L
authors.lastname: Giraldo-Cadavid
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia; Division of Gastroenterology and Endoscopy, Universidad de La Sabana, Bogotá DC, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Osorio
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome