Fabian Emura1, Juan Mejía2, Alberto Donneys3, Orlando Ricaurte4, Luis Sabbagh5, Luis Giraldo-Cadavid6, Ichiro Oda7, Yutaka Saito7, Camilo Osorio8. 1. Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC, Colombia; Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia; Division of Gastroenterology and Endoscopy, Universidad de La Sabana, Bogotá DC, Colombia; Centro de Exploraciones Digestivas, Clínica Universitaria Colombia, Bogotá DC, Colombia. 2. Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC, Colombia. 3. Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia. 4. Department of Pathology, Universidad Nacional de Colombia, Bogotá DC, Colombia. 5. Centro de Exploraciones Digestivas, Clínica Universitaria Colombia, Bogotá DC, Colombia. 6. Department of Internal Medicine, Universidad de La Sabana, Bogotá DC, Colombia. 7. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 8. Emura Foundation for the Promotion of Cancer Research, Bogotá DC, Colombia; Division of Gastroenterology and Endoscopy, Universidad de La Sabana, Bogotá DC, Colombia.
Abstract
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.
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.
Authors: R Bausys; A Bausys; J Stanaitis; I Vysniauskaite; K Maneikis; B Bausys; E Stratilatovas; K Strupas Journal: Surg Endosc Date: 2018-12-03 Impact factor: 4.584
Authors: Nancy Roxana Machaca Quea; Fabian Emura; Fernando Barreda Bolaños; Yuliana Salvador Arias; Fernando Antonio Arévalo Suárez; Alejandro Piscoya Rivera Journal: Endosc Int Open Date: 2016-10
Authors: Dane Christina Daoud; Nicolas Suter; Madeleine Durand; Mickael Bouin; Bernard Faulques; Daniel von Renteln Journal: World J Gastroenterol Date: 2018-06-21 Impact factor: 5.742