Seong Woo Jeon1,2, Hyun Woo Park3, Yong Hwan Kwon3,4, Su Youn Nam3, Hyun Seok Lee3,4. 1. Gastric Cancer Center, Kyungpook National University Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41410, South Korea. swjeon@knu.ac.kr. 2. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea. swjeon@knu.ac.kr. 3. Gastric Cancer Center, Kyungpook National University Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41410, South Korea. 4. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Abstract
BACKGROUND: The inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to additional surgery because of a non-curative resection. This study was performed to assess the accuracy of clinical decisions in ESD for EGC. METHODS: A total of 607 cases of EGC treated by ESD were prospectively enrolled from January 2011 to June 2014 at a single academic hospital. The 607 EGCs were divided into three groups (overestimated, same-estimated, and underestimated) based on pre-procedure endoscopic findings (indication) and pathological diagnosis after ESD (criteria). We evaluated the discrepancy rates between pre-procedure indication and pathological criteria, and then analyzed the pre-procedure factors that could influence the occurrence of the discrepancies. RESULTS: The absolute, expanded, and beyond the expanded indication has its accuracy on curability criteria in 87%, 77.6%, and 55.6% of cases, respectively. The ratio of overall indication-criteria discrepancies was 250/607 (41.2%). The curability was significantly lower in the underestimated group compared to the overestimated and same-estimated groups (41.6% vs. 94.6%, 94.4%, p < 0.001). In multivariate analysis examining the predictive factors for discrepancies in the 598 EGCs with absolute/expanded indications, the endoscopic size ≥ 20 mm [odds ratio (OR) 2.493, confidence interval (CI) 1.546-4.022, p < 0.001], presence of ulcers (OR 1.712, CI 1.070-2.738, p = 0.025), patient age < 60 years (OR 1.689, CI 1.044-2.733, p = 0.033), and undifferentiated type EGC on forceps biopsy (OR 5.397, CI 2.027-14.369, p = 0.001) were all associated with discrepancies. CONCLUSIONS: Indication judged by pre-procedural endoscopy is not sufficiently accurate to be used as a good measurement for post-procedural criteria.
BACKGROUND: The inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to additional surgery because of a non-curative resection. This study was performed to assess the accuracy of clinical decisions in ESD for EGC. METHODS: A total of 607 cases of EGC treated by ESD were prospectively enrolled from January 2011 to June 2014 at a single academic hospital. The 607 EGCs were divided into three groups (overestimated, same-estimated, and underestimated) based on pre-procedure endoscopic findings (indication) and pathological diagnosis after ESD (criteria). We evaluated the discrepancy rates between pre-procedure indication and pathological criteria, and then analyzed the pre-procedure factors that could influence the occurrence of the discrepancies. RESULTS: The absolute, expanded, and beyond the expanded indication has its accuracy on curability criteria in 87%, 77.6%, and 55.6% of cases, respectively. The ratio of overall indication-criteria discrepancies was 250/607 (41.2%). The curability was significantly lower in the underestimated group compared to the overestimated and same-estimated groups (41.6% vs. 94.6%, 94.4%, p < 0.001). In multivariate analysis examining the predictive factors for discrepancies in the 598 EGCs with absolute/expanded indications, the endoscopic size ≥ 20 mm [odds ratio (OR) 2.493, confidence interval (CI) 1.546-4.022, p < 0.001], presence of ulcers (OR 1.712, CI 1.070-2.738, p = 0.025), patient age < 60 years (OR 1.689, CI 1.044-2.733, p = 0.033), and undifferentiated type EGC on forceps biopsy (OR 5.397, CI 2.027-14.369, p = 0.001) were all associated with discrepancies. CONCLUSIONS: Indication judged by pre-procedural endoscopy is not sufficiently accurate to be used as a good measurement for post-procedural criteria.
Authors: Tae Hee Lee; Joo Young Cho; Young Woon Chang; Jin-Oh Kim; Joon Seong Lee; Won Young Cho; Hyun Gun Kim; Wan Jung Kim; Youn Sun Park; So Young Jin Journal: Gastrointest Endosc Date: 2010-03-24 Impact factor: 9.427
Authors: Keun Young Shin; Seong Woo Jeon; Kwang Bum Cho; Kyung Sik Park; Eun Soo Kim; Chang Keun Park; Yun Jin Chung; Joong Goo Kwon; Jin Tae Jung; Eun Young Kim; Kyeong Ok Kim; Byung Ik Jang; Si Hyung Lee; Jeong Bae Park; Chang Hun Yang Journal: Gut Liver Date: 2015-03 Impact factor: 4.519