Original ArticleClinical EndoscopyAdvantage of endoscopic submucosal dissection compared with EMR for early gastric cancer
Section snippets
Patients and methods
A retrospective analysis was performed of 1020 EGCs resected endoscopically in 896 patients at Hiroshima University Hospital from April 1990 through December 2004. Informed consent was obtained from all patients before endoscopic resection was performed. For all lesions, the expanded criteria for endoscopic treatment were fulfilled.9 Beginning in June 2002, when ESD for EGC was introduced in our hospital, all lesions were resected by ESD. For the purpose of this study, the lesions were
Results
Clinicopathologic features of the EGCs are shown in Table 1. EMR tumors ranged from 4 to 90 mm in maximum diameter (14.6 ± 9.4 mm), and ESD tumors ranged from 5 to 100 mm in maximum diameter (19.4 ± 13.2 mm). Differences in the average tumor diameter and the location between the 2 groups were not significant. The relative frequencies of the depressed type, the undifferentiated type, ulceration, and submucosal invasion in the ESD group were significantly higher than those in the EMR group (P <
Discussion
In this study, there were several clinicopathologic differences between the EMR and ESD groups. Perhaps videoendoscopy has improved detection of depressed-type EGCs or perhaps we tended to perform ESD instead of open surgery for undifferentiated type EGCs less than 20 mm in size. It is reported that tumor size and location of the EGC are important factors that affect the success of en bloc resection.19 In addition, the en bloc resection rate for lesions without ulceration was significantly
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