Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection

S. Oka; S. Tanaka; I. Kaneko; R. Mouri; M. Hirata; H. Kanao; T. Kawamura; S. Yoshida; M. Yoshihara; K. Chayama

doi:10.1055/s-2006-944780

Endoscopy 2006; 38(10): 996-1000
DOI: 10.1055/s-2006-944780

Original article

Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection

S. Oka¹ , S. Tanaka¹ , I. Kaneko² , R. Mouri² , M. Hirata² , H. Kanao² , T. Kawamura¹ , S. Yoshida¹ , M. Yoshihara² , K. Chayama²

¹Dept. of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
²Dept. of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

Abstract

Background and study aims: Endoscopic mucosal resection (EMR) is a widely accepted treatment for early gastric cancer; however, incomplete resection with residual local disease and recurrences continues to be a difficult problem. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for residual/local recurrent early gastric cancer lesions after EMR.
Patients and methods: The en bloc resection rate, histologically complete resection rate, complications, and local recurrence were assessed in 15 patients who underwent ESD for residual/local recurrent early gastric cancer lesions after EMR.
Results: The nonlifting sign after injection of a glycerin solution was positive due to scar formation in all cases. En bloc resection was attempted in all cases, with a complete resection rate of 93.3 % (14 of 15). The lesion was completely resected with histologically adequate margins in the 14 patients who received complete en bloc resection. The average operation time was 85.4 ± 52.9 min, and the mean follow-up period for all patients was 18.1 ± 7.4 months. Major bleeding during the procedure in one case was the only complication (one of 15, 6.7 %). None of the patients experienced recurrence of early gastric cancer after ESD.
Conclusions: ESD appears to be a safe and effective treatment for residual/local recurrent early gastric cancer lesions after EMR, and it is useful for histological confirmation of successful treatment.

Volltext

Referenzen

References

1 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer. Endoscopy. 1993; 25 445-450
2 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001; 48 225-229
3 Torii A, Sakai M, Kajiyama T. et al . Endoscopic aspiration mucosectomy as curative endoscopic surgery; analysis of 24 cases of early gastric cancer. Gastrointest Endosc. 1995; 42 475-479
4 Suzuki Y, Hiraishi H, Kanke K. et al . Treatment of gastric tumors by endoscopic mucosal resection with a ligating device. Gastrointest Endosc. 1999; 49 192-199
5 Kojima T, Parra-Blanco A, Takahashi H. et al . Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc. 1998; 48 550-555
6 Tada M, Tokiyana H, Nakamura H. et al . Criteria for evaluation of the need for multiple resection after imperfect resection during endoscopic therapy for early gastric cancer [in Japanese with English abstract]. Stomach Intestine. 1998; 33 1559-1565
7 Oka S, Tanaka S, Kaneko I. et al . Advantage of endoscopic submucosal dissection in comparison to endoscopic mucosal resection for early gastric cancer. Gastrointest Endosc. 2006; in press
8 Yasuda K, Mizuma Y, Nakajima M. et al . Endoscopic laser treatment for early gastric cancer. Endoscopy. 1993; 25 451-454
9 Kitamura T, Tanabe S, Koizumi W. et al . Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc. 2006; 63 48-54
10 Takagi K, Iwakiri K, Matsuoka S. et al . EMR performed four times for residual IIa cancer of the gastric angle: report of a case [in Japanese with English abstract]. Stomach Intestine. 1998; 33 1749-1754
11 Ashida K, Egashira Y, Tanaka M. et al . Early gastric cancer with remains of cancer cells extensively in the mucosa by EMR: report of a case [in Japanese with English abstract]. Stomach Intestine. 1996; 31 1139-1143
12 Misumi A, Murakami A, Honmyo U. et al . Treatment of remnants and recurrence after EMR on the basis of analysis of gastrectomy cases [in Japanese with English abstract]. Stomach Intestine. 2001; 37 1201-1209
13 Ohkuwa M, Hosokawa K, Boku N. et al . New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy. 2001; 33 221-226
14 Oda I, Gotoda T, Hamanaka H. et al . Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc. 2005; 17 S54-S58
15 Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5 1-5
16 Tajiri H, Kitano S. Complications associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc. 2004; 16 S134-S136
17 Japanese Research Society for Gastric Cancer .Japanese classification of gastric carcinoma. Tokyo; Kanehara 1999
18 Fujisaki J, Matsuda K, Tajiri H. Endoscopic mucosal resection for early gastric cancer: aiming at safety, speed, and reliability. Dig Endosc. 2003; 15 S8-S11
19 Murakami S, Tanabe S, Koizumi W. et al . Endoscopic mucosal resection (EMR) for the management of poorly differentiated adenocarcinoma of the stomach: a patient who had recurrence and died 4 years after EMR. Gastric Cancer. 2003; 6 113-116
20 Yano H, Kimura Y, Iwazawa T. et al . Laparoscopic management for local recurrence of early gastric cancer after endoscopic mucosal resection. Surg Endosc. 2005; 19 981-985

S. Tanaka, M. D., Ph. D.

Dept. of Endoscopy

Hiroshima University Hospital · 1-2-3 Kasumi, Minami-ku · Hiroshima 734-8551 · Japan

Fax: +81-82-257-5538

eMail: colon@hiroshima-u.ac.jp