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.
Design/Setting
Consecutive case series performed by an expertly trained Western endoscopist.
Patients
Fifty-three patients with 54 lesions.
Interventions
ESD for early gastric cancers (T1) satisfying expanded inclusion criteria.
Main Outcome Measurements
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.
Limitation
Long-term outcome data are currently unavailable.
Conclusion
ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western
endoscopy setting comparable to those achieved at major Japanese institutions.
Abbreviations:
EGC (early gastric cancer), ESD (endoscopic submucosal dissection), HGD (high-grade dysplasia), SACE (systematic alphanumeric coded endoscopy), SM (submucosal)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 05, 2015
Accepted:
March 13,
2015
Received:
October 4,
2014
Footnotes
DISCLOSURE: This work was supported in part by a grant-in-aid for the Comprehensive Strategy to Control Cancer in the Americas from the Emura Foundation for the Promotion of Cancer Research. All authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Emura at [email protected]
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
