Joong Keun Kim1, Gwang Ha Kim2, Bong Eun Lee1, Chul Hong Park1, Hye Kyung Jeon1, Dong Hoon Baek1, Geun Am Song1. 1. Departments of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. 2. Departments of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. doc0224@pusan.ac.kr.
Abstract
BACKGROUND: Surgical resection for esophagogastric junction (EGJ) tumors is more aggressive and worsens the quality of life of the patients and leads to poor prognosis even after surgery compared with tumors in other sites of the stomach. Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach. However, EGJ tumor is one of the most technically difficult lesions to resect by ESD. Therefore, this study aimed to evaluate the therapeutic outcomes of ESD for EGJ epithelial neoplasms and to assess the predictive factors for incomplete resection. METHODS: We conducted a retrospective observational study of 48 patients who underwent ESD for adenomas and early cancers of the EGJ between March 2006 and November 2015 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related adverse events were analyzed. RESULTS: En bloc resection, complete resection, and curative resection rates were 96, 77, and 71%, respectively. Multivariate analyses showed that the presence of ulceration was an independent predictive factor for incomplete resection (odds ratio 21.3, 95% confidence interval 1.51-298.49; p = 0.023). The procedure-related bleeding, perforation, and stenosis rates were 8, 4, and 0%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range 6-72 months), local recurrence occurred in four patients with incomplete resection. CONCLUSION: ESD is an effective, safe, and feasible treatment for EGJ epithelial neoplasms. However, the complete resection rate decreases for tumors with ulceration.
BACKGROUND: Surgical resection for esophagogastric junction (EGJ) tumors is more aggressive and worsens the quality of life of the patients and leads to poor prognosis even after surgery compared with tumors in other sites of the stomach. Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach. However, EGJ tumor is one of the most technically difficult lesions to resect by ESD. Therefore, this study aimed to evaluate the therapeutic outcomes of ESD for EGJ epithelial neoplasms and to assess the predictive factors for incomplete resection. METHODS: We conducted a retrospective observational study of 48 patients who underwent ESD for adenomas and early cancers of the EGJ between March 2006 and November 2015 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related adverse events were analyzed. RESULTS: En bloc resection, complete resection, and curative resection rates were 96, 77, and 71%, respectively. Multivariate analyses showed that the presence of ulceration was an independent predictive factor for incomplete resection (odds ratio 21.3, 95% confidence interval 1.51-298.49; p = 0.023). The procedure-related bleeding, perforation, and stenosis rates were 8, 4, and 0%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range 6-72 months), local recurrence occurred in four patients with incomplete resection. CONCLUSION: ESD is an effective, safe, and feasible treatment for EGJ epithelial neoplasms. However, the complete resection rate decreases for tumors with ulceration.
Authors: Prateek Sharma; Kenneth McQuaid; John Dent; M Brian Fennerty; Richard Sampliner; Stuart Spechler; Alan Cameron; Douglas Corley; Gary Falk; John Goldblum; John Hunter; Janusz Jankowski; Lars Lundell; Brian Reid; Nicholas J Shaheen; Amnon Sonnenberg; Kenneth Wang; Wilfred Weinstein Journal: Gastroenterology Date: 2004-07 Impact factor: 22.682
Authors: A Imagawa; H Okada; Y Kawahara; R Takenaka; J Kato; H Kawamoto; S Fujiki; R Takata; T Yoshino; Y Shiratori Journal: Endoscopy Date: 2006-10 Impact factor: 10.093
Authors: Ji Yong Ahn; Hwoon-Yong Jung; Kee Don Choi; Ji Young Choi; Mi-Young Kim; Jeong Hoon Lee; Kwi-Sook Choi; Do Hoon Kim; Ho June Song; Gin Hyug Lee; Jin-Ho Kim; Young Soo Park Journal: Gastrointest Endosc Date: 2011-07-13 Impact factor: 9.427
Authors: Ji Yong Ahn; Kee Don Choi; Ji Young Choi; Mi-Young Kim; Jeong Hoon Lee; Kwi-Sook Choi; Do Hoon Kim; Ho June Song; Gin Hyug Lee; Hwoon-Yong Jung; Jin-Ho Kim Journal: Gastrointest Endosc Date: 2011-02-05 Impact factor: 9.427