Elsevier

Gastrointestinal Endoscopy

Volume 64, Issue 6, December 2006, Pages 877-883
Gastrointestinal Endoscopy

Original Article
Clinical Endoscopy
Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer

https://doi.org/10.1016/j.gie.2006.03.932Get rights and content

Background

In EMR of early gastric cancer (EGC), en bloc resection reduces the risk of residual cancer. Endoscopic submucosal dissection (ESD) now allows en bloc resection of large EGCs.

Objective

To retrospectively determine whether ESD is more advantageous than EMR for EGCs.

Design

EMR (825 lesions, 711 patients) or ESD (195 lesions, 185 patients) was performed. The en bloc resection rate, histologically complete resection rate, operation time, complications, and local recurrence rate were studied in relation to ulceration.

Setting

Hiroshima University Hospital.

Patients

Subjects comprised 896 patients in whom 1020 EGCs were resected endoscopically from 1990 to 2004.

Results

In cases without ulceration, en bloc and histologically complete resection rates were significantly higher with ESD than with EMR, regardless of tumor size. The frequency of ulceration did not differ significantly between groups. Average operation time was significantly longer for ESD than for EMR, regardless of tumor size. Also, regardless of ulceration, the incidence of intraoperative bleeding was significantly higher with ESD (22.6%) than with EMR (7.6%). Delayed bleeding did not differ. In cases with ulceration, the incidence of perforation was significantly higher with ESD (53.8%) than with EMR (2.9%). Local recurrences were treated by incomplete EMR (en bloc, 2.9%; piecemeal, 4.4%). No patient experienced recurrence after ESD.

Conclusions

ESD increased en bloc and histologically complete resection rates and may reduce the local recurrence rate. Increased operation time and complication risks with ESD in comparison with EMR remain problematic. Special measures are necessary for ESD of ulcerated lesions to reduce the rates of perforation and incomplete resection.

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

References (27)

  • M. Tada et al.

    Endoscopic resection of early gastric cancer

    Endoscopy

    (1993)
  • H. Inoue et al.

    Treatment of esophageal and gastric tumors

    Endoscopy

    (1999)
  • H. Ono et al.

    Endoscopic mucosal resection for treatment of early gastric cancer

    Gut

    (2001)
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