title: Gastric ESD may be useful as accurate staging and decision of future therapeutic strategy.
abstract: Background and study aimsWe sometimes perform gastric endoscopic submucosal dissection (ESD) for total pathologic diagnosis when preoperative diagnosis is difficult. In the present study we analyzed the treatment outcomes and adverse events of diagnostic ESD for early gastric cancer (EGC).Patients and methodsWe conducted a retrospective analysis of 18 consecutive cases of EGC in 18 patients with a suspected out-of-indication diagnosis who underwent diagnostic ESD, between June 2010 and November 2014. The following parameters were examined: the average length of the longer axis of the lesion; the procedure time; the rates of en bloc resection (ER), complete en bloc resection (CER), and curative resection (CR) as treatment outcomes; and the rates of perforation, delayed bleeding, aspiration pneumonia, disease-related death, and emergency surgery as adverse events.ResultsThe treatment outcomes were as follows: average length of the longer axis of the lesion, 27.4 ± 10.0 mm; procedure time, 87.0 ± 43.1 minutes; ER rate, 18/18 (100.0 %); CER rate, 13/18 (72.2 %); CR rate, 4/18 (22.2 %). CR rate was achieved 37.5 % for the lesions which preoperative diagnosis was more than 30 mm (> 30 mm) in diameter differentiated type with mucosal layer/submucosal layer 1 invasion and ulceration positive. The adverse events (AEs) were perforation in 1 of 18 (5.5 %) patients and delayed bleeding in 1 of 18 (5.5 %). There were no other AEs.ConclusionsDiagnostic ESD may be acceptable for future therapeutic strategy when we unconfirmed the pre ESD diagnosis because of lower rate of adverse events and high rate of ER.
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Fujimoto
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nishizawa
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ochiai
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Maehata
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kinoshita
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Sagara
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.affiliation: Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi