BACKGROUND: Endoscopic submucosal dissection (ESD) yields substantially high rates for curative resection of early gastric cancer (EGC). It is suggested that larger, ulcerative, or upper EGCs may prevent successful ESD. A detailed analysis of factors associated with the curability of ESD was performed. METHODS: Endoscopic submucosal dissection was performed for patients with EGC that fulfilled the expanded criteria, which specified mucosal cancer without ulcer findings irrespective of tumor size, mucosal cancer with ulcers 3 cm in diameter or smaller, and minute submucosal invasive cancer 3 cm or smaller. Resectability (en bloc or by piecemeal resection), curability (curative or non-curative), and complications were assessed, and logistic regression analysis was used to analyze the related factors. RESULTS: Ulcerative EGCs showed a significantly higher risk associated with ESD on multivariate analysis. When the risk factors (tumor size, location, and ulcer findings) were combined, the larger EGCs (>30 mm) located in the upper third or ulcerative tumors located in the upper and middle portion of the stomach were at significantly higher risk of non-curative resection. Such lesions also were associated with increased risk of procedure-related perforation. CONCLUSIONS: When risk factors including positive ulcer findings and larger size and upper location of tumors are combined, ESD should be performed more carefully.
BACKGROUND: Endoscopic submucosal dissection (ESD) yields substantially high rates for curative resection of early gastric cancer (EGC). It is suggested that larger, ulcerative, or upper EGCs may prevent successful ESD. A detailed analysis of factors associated with the curability of ESD was performed. METHODS: Endoscopic submucosal dissection was performed for patients with EGC that fulfilled the expanded criteria, which specified mucosal cancer without ulcer findings irrespective of tumor size, mucosal cancer with ulcers 3 cm in diameter or smaller, and minute submucosal invasive cancer 3 cm or smaller. Resectability (en bloc or by piecemeal resection), curability (curative or non-curative), and complications were assessed, and logistic regression analysis was used to analyze the related factors. RESULTS: Ulcerative EGCs showed a significantly higher risk associated with ESD on multivariate analysis. When the risk factors (tumor size, location, and ulcer findings) were combined, the larger EGCs (>30 mm) located in the upper third or ulcerative tumors located in the upper and middle portion of the stomach were at significantly higher risk of non-curative resection. Such lesions also were associated with increased risk of procedure-related perforation. CONCLUSIONS: When risk factors including positive ulcer findings and larger size and upper location of tumors are combined, ESD should be performed more carefully.
Authors: S Oka; S Tanaka; I Kaneko; R Mouri; M Hirata; H Kanao; T Kawamura; S Yoshida; M Yoshihara; K Chayama Journal: Endoscopy Date: 2006-10 Impact factor: 10.093
Authors: Ji Young Yoon; Choong Nam Shim; Sook Hee Chung; Wan Park; Hyunsoo Chung; Hyuk Lee; Sung Kwan Shin; Sang Kil Lee; Yong Chan Lee; Jun Chul Park Journal: World J Gastroenterol Date: 2014-07-14 Impact factor: 5.742
Authors: Yu Sik Myung; Su Jin Hong; Jae Pil Han; Kyung Woo Park; Bong Min Ko; Moon Sung Lee Journal: Gastric Cancer Date: 2015-12-11 Impact factor: 7.370