Endoscopy 2006; 38(10): 980-986
DOI: 10.1055/s-2006-944809
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection for early gastric cancers and large flat adenomas

Y.  Onozato1 , H.  Ishihara1 , H.  Iizuka1 , N.  Sohara2 , S.  Kakizaki2 , S.  Okamura2 , M.  Mori2
  • 1Gastroenterology Center, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
  • 2Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Further Information

Publication History

Submitted 21 June 2006

Accepted after revision 3 July 2006

Publication Date:
20 October 2006 (online)

Background and study aim: Endoscopic submucosal dissection (ESD) is a new diagnostic and treatment technique for early gastric cancer (EGC). The present study aims to identify the technical feasibility, operation time, and complications associated with ESD.
Methods: We reviewed the patients who underwent ESD for EGCs at Maebashi Red Cross Hospital.
Results: There were 160 patients with 171 EGCs treated by ESD. The mean age was 71.4 ± 8.9 years (median 72). The rate for one-piece resection with tumor-free margins was 94.2 % (161/171), and was 93.2 % (82/88) for large lesions (> 20 mm) and 92.1 % (35/38) for ulcerative lesions. The median operation time was 80 min (range 10-600 min). Evidence of immediate bleeding was found in 2.9 % (5/171), delayed bleeding was seen in 7.6 % (13/171), and perforation was observed in 3.5 % (6/171) of the lesions. All patients with complications, including perforation, were successfully treated endoscopically. There were no local or distant metastases in the lesions which met our indication criteria for ESD.
Conclusion: The present study shows the technical feasibility of ESD, which provides the capability of one-piece resection even in large and ulcerative lesions.

References

  • 1 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
  • 2 Ahmad N A, Kochman M L, Long W B. et al . Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases.  Gastrointest Endosc. 2002;  55 390-396
  • 3 Japanese Gastric Cancer Association .Guidelines for the treatment of gastric cancer. Tokyo; Kanehara & Co 2001
  • 4 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-451
  • 5 Tanabe S, Koizumi W, Kokutou M. et al . Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer.  Gastrointest Endosc. 1999;  50 819-822
  • 6 Gotoda T, Yanagisawa A, Sasako M. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
  • 7 Hirao M, Masuda K, Asanuma T. et al . Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine.  Gastrointest Endosc. 1988;  34 264-269
  • 8 Gotoda T, Kondo H, Ono H. et al . A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions.  Gastrointest Endosc. 1999;  50 560-563
  • 9 Yamamoto H, Kawata H, Sunada K. et al . Successful one-piece resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.  Endoscopy. 2003;  35 690-694
  • 10 Japanese Gastric Cancer Association . Japanese classification of gastric carcinoma. 2nd English edn.  Gastric Cancer. 1998;  1 11
  • 11 Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature.  Gastrointest Endosc. 1998;  48 550-554
  • 12 Yamamoto H. Endoscopic submucosal dissection of early cancers and large flat adenomas.  Clin Gastroenterol Hepatol. 2005;  3 S74-S76
  • 13 Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract - Hook knife EMR method.  Min Invas Ther Allied Technol. 2002;  11 291-295
  • 14 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
  • 15 Rosch T, Sarbia M, Schumacher B. et al . Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series.  Endoscopy. 2004;  36 788-801
  • 16 Oda I, Goyoda T, Hamanaka H. et al . Endscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series.  Dig Endosc. 2005;  17 54-58

S. Kakizaki, M. D., PhD

Department of Medicine and Molecular Science

Gunma University Graduate School of Medicine · 3-39-15 Showa-machi · Maebashi, Gunma 371-8511 · Japan

Fax: +81-27-2208136·

Email: kakizaki@showa.gunma-u.ac.jp