title: Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions.
abstract: The prognosis of early gastric cancer (EGC) is good if there is no concomitant lymph node metastasis. Therefore, the early detection of EGC is important to improve the prognosis of patients with gastric cancer. In Japan, 40% to 50% of all gastric cancers are EGC, and endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for these lesions, particularly for large lesions that at one time were an indication for gastrectomy because of the difficulty of en-bloc resection. Consequently, this procedure can preserve the entire stomach and the patient's postoperative quality of life. ESD has become a general technique with improved procedures and devices, and has become the preferred treatment for EGC rather than gastrectomy. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities, particularly elderly population, patients taking antithrombotic agents, or patients with chronic kidney disease, or liver cirrhosis. However, it is not yet clear whether patients with both EGC and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in patients with EGC and those comorbid conditions.
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoshio
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Yoshioka
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Michida
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujii
authors.affiliation: Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
keywords: Antithrombotic agents; Chronic kidney disease; Elderly person; Endoscopic submucosal dissection; Gastric cancer; Liver cirrhosis