title: Therapeutic Decision-Making Using Endoscopic Ultrasonography in Endoscopic Treatment of Early Gastric Cancer.
abstract: OBJECTIVE
  We evaluated the effectiveness of an endoscopic ultrasonography (EUS)-based treatment plan compared to an endoscopy-based treatment plan in selecting candidates with early gastric cancer (EGC) for endoscopic submucosal dissection based on the prediction of invasion depth.
  
  
  METHODS
  We reviewed 393 EGCs with differentiated histology from 380 patients who underwent EUS from July 2007 to April 2010. The effectiveness of the EUS-based and endoscopy-based plans was evaluated using a simplified hypothetical treatment algorithm.
  
  
  RESULTS
  The numbers of endoscopically determined mucosal, indeterminate, and submucosal cancers were 253 (64.4%), 56 (14.2%), and 84 (21.4%), respectively. Overall, the appropriate treatment selection rates were 75.3% (296/393) in the endoscopy-based plan and 71.5% (281/393) in the EUS-based plan (p=0.184). For endoscopic mucosal cancers, the appropriate treatment selection rates in the endoscopy-based plan were 88.1% (223/253), while the use of an EUS-based plan significantly decreased this rate to 81.4% (206/253) (p=0.036). For endoscopic submucosal cancers, the appropriate selection rates did not differ between the endoscopy-based plan (46.4%, 39/84) and the EUS-based plan (53.6%, 45/84) (p=0.070).
  
  
  CONCLUSIONS
  EUS did not increase the likelihood of selecting the appropriate treatment in differentiated-type EGC. Therefore, EUS may not be necessary before treating differentiated-type EGC, especially in endoscopically presumed mucosal cancers.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000066491:Clinical Decision-Making / Q000379:methods*; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D019160:Endosonography / Q000706:statistics & numerical data*; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Conventional endoscopy; Early gastric cancer; Endoscopic submucosal dissection; Endosonography