Endoscopic submucosal dissection for early gastric cancer: Results and degrees of technical difficulty as well as sucsess

A. Imagawa, Hiroyuki Okada, Yoshiro Kawahara, R. Takenaka, J. Kato, H. Kawamoto, S. Fujiki, R. Takata, Tadashi Yoshino, Y. Shiratori

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) is a new method for the curative treatment of early gastrointestinal neoplasms, which was developed in order to increase the en bloc and RO resection rate, especially for lesions larger than 20 mm in diameter. Drawbacks of ESD include the fact that it is technically a substantially more difficult procedure and that it is associated with a higher perforation rate. A retrospective study was therefore carried out to analyze cases in relation to the procedure time and resection success, and these factors were correlated with the characteristics of the lesions. Patients and methods: From January 2002 to November 2005, 196 lesions in 185 patients with early gastric cancer were treated using ESD in our hospital. The rates of curative en bloc resection, the incidence of perforation, and the procedure times were analyzed in relation to lesion size (small, 20 mm or less in diameter; large, over 20 mm), location (upper, middle, or lower third of the stomach) and the presence or absence of ulceration. Results: The rate of curative en bloc resection was 84 % (93 % of the lesions overall were resected in one piece), with a perforation rate of 6.1 % (all perforations were managed endoscopically) and a mean procedure time of 68 min. The rate of curative en bloc resection differed significantly depending on the location of the lesion (upper vs. middle vs. lower, 74 % vs. 77 % vs. 91 %; P<0.05), as well as on the size of the lesion (> 20 mm vs. 20 mm or less, 59 % vs. 89%; P 20 mm vs. 20 mm or less, 124 min vs. 55 min; P<0.0001), as well as the presence of ulceration (positive vs. negative, 97 min vs. 65 min; P <0.05). With regard to perforation rates, significant differences were also observed in relation to the location of the lesion (upper vs. middle vs. lower, 22.6 % vs. 2.8 % vs. 3.2 %; P <0.0005) and size of the lesion (> 20 mm vs. 20 mm or less, 16.2 % vs. 3.8 %; P <0.005). No local recurrences of curatively resected lesions (n = 119) were observed after a follow-up period of 1 year. Conclusions: The difficulty of ESD depends on the location and size of the lesion, as well as on the presence of ulceration. We would recommend that trainees should begin by carrying out ESD on lesions with a diameter of less than 20 mm without ulceration that are located in the lower third of the stomach.

Original languageEnglish
Pages (from-to)987-990
Number of pages4
JournalEndoscopy
Volume38
Issue number10
DOIs
Publication statusPublished - Oct 2006

Fingerprint

Stomach Neoplasms
Stomach
Gastrointestinal Neoplasms
Endoscopic Mucosal Resection
Retrospective Studies
Recurrence
Incidence

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Endoscopic submucosal dissection for early gastric cancer : Results and degrees of technical difficulty as well as sucsess. / Imagawa, A.; Okada, Hiroyuki; Kawahara, Yoshiro; Takenaka, R.; Kato, J.; Kawamoto, H.; Fujiki, S.; Takata, R.; Yoshino, Tadashi; Shiratori, Y.

In: Endoscopy, Vol. 38, No. 10, 10.2006, p. 987-990.

Research output: Contribution to journalArticle

Imagawa, A. ; Okada, Hiroyuki ; Kawahara, Yoshiro ; Takenaka, R. ; Kato, J. ; Kawamoto, H. ; Fujiki, S. ; Takata, R. ; Yoshino, Tadashi ; Shiratori, Y. / Endoscopic submucosal dissection for early gastric cancer : Results and degrees of technical difficulty as well as sucsess. In: Endoscopy. 2006 ; Vol. 38, No. 10. pp. 987-990.
@article{d67e060cdc394102b47c3f81fd9d3535,
title = "Endoscopic submucosal dissection for early gastric cancer: Results and degrees of technical difficulty as well as sucsess",
abstract = "Background and study aims: Endoscopic submucosal dissection (ESD) is a new method for the curative treatment of early gastrointestinal neoplasms, which was developed in order to increase the en bloc and RO resection rate, especially for lesions larger than 20 mm in diameter. Drawbacks of ESD include the fact that it is technically a substantially more difficult procedure and that it is associated with a higher perforation rate. A retrospective study was therefore carried out to analyze cases in relation to the procedure time and resection success, and these factors were correlated with the characteristics of the lesions. Patients and methods: From January 2002 to November 2005, 196 lesions in 185 patients with early gastric cancer were treated using ESD in our hospital. The rates of curative en bloc resection, the incidence of perforation, and the procedure times were analyzed in relation to lesion size (small, 20 mm or less in diameter; large, over 20 mm), location (upper, middle, or lower third of the stomach) and the presence or absence of ulceration. Results: The rate of curative en bloc resection was 84 {\%} (93 {\%} of the lesions overall were resected in one piece), with a perforation rate of 6.1 {\%} (all perforations were managed endoscopically) and a mean procedure time of 68 min. The rate of curative en bloc resection differed significantly depending on the location of the lesion (upper vs. middle vs. lower, 74 {\%} vs. 77 {\%} vs. 91 {\%}; P<0.05), as well as on the size of the lesion (> 20 mm vs. 20 mm or less, 59 {\%} vs. 89{\%}; P 20 mm vs. 20 mm or less, 124 min vs. 55 min; P<0.0001), as well as the presence of ulceration (positive vs. negative, 97 min vs. 65 min; P <0.05). With regard to perforation rates, significant differences were also observed in relation to the location of the lesion (upper vs. middle vs. lower, 22.6 {\%} vs. 2.8 {\%} vs. 3.2 {\%}; P <0.0005) and size of the lesion (> 20 mm vs. 20 mm or less, 16.2 {\%} vs. 3.8 {\%}; P <0.005). No local recurrences of curatively resected lesions (n = 119) were observed after a follow-up period of 1 year. Conclusions: The difficulty of ESD depends on the location and size of the lesion, as well as on the presence of ulceration. We would recommend that trainees should begin by carrying out ESD on lesions with a diameter of less than 20 mm without ulceration that are located in the lower third of the stomach.",
author = "A. Imagawa and Hiroyuki Okada and Yoshiro Kawahara and R. Takenaka and J. Kato and H. Kawamoto and S. Fujiki and R. Takata and Tadashi Yoshino and Y. Shiratori",
year = "2006",
month = "10",
doi = "10.1055/s-2006-944716",
language = "English",
volume = "38",
pages = "987--990",
journal = "Endoscopy",
issn = "0013-726X",
publisher = "Georg Thieme Verlag",
number = "10",

}

TY - JOUR

T1 - Endoscopic submucosal dissection for early gastric cancer

T2 - Results and degrees of technical difficulty as well as sucsess

AU - Imagawa, A.

AU - Okada, Hiroyuki

AU - Kawahara, Yoshiro

AU - Takenaka, R.

AU - Kato, J.

AU - Kawamoto, H.

AU - Fujiki, S.

AU - Takata, R.

AU - Yoshino, Tadashi

AU - Shiratori, Y.

PY - 2006/10

Y1 - 2006/10

N2 - Background and study aims: Endoscopic submucosal dissection (ESD) is a new method for the curative treatment of early gastrointestinal neoplasms, which was developed in order to increase the en bloc and RO resection rate, especially for lesions larger than 20 mm in diameter. Drawbacks of ESD include the fact that it is technically a substantially more difficult procedure and that it is associated with a higher perforation rate. A retrospective study was therefore carried out to analyze cases in relation to the procedure time and resection success, and these factors were correlated with the characteristics of the lesions. Patients and methods: From January 2002 to November 2005, 196 lesions in 185 patients with early gastric cancer were treated using ESD in our hospital. The rates of curative en bloc resection, the incidence of perforation, and the procedure times were analyzed in relation to lesion size (small, 20 mm or less in diameter; large, over 20 mm), location (upper, middle, or lower third of the stomach) and the presence or absence of ulceration. Results: The rate of curative en bloc resection was 84 % (93 % of the lesions overall were resected in one piece), with a perforation rate of 6.1 % (all perforations were managed endoscopically) and a mean procedure time of 68 min. The rate of curative en bloc resection differed significantly depending on the location of the lesion (upper vs. middle vs. lower, 74 % vs. 77 % vs. 91 %; P<0.05), as well as on the size of the lesion (> 20 mm vs. 20 mm or less, 59 % vs. 89%; P 20 mm vs. 20 mm or less, 124 min vs. 55 min; P<0.0001), as well as the presence of ulceration (positive vs. negative, 97 min vs. 65 min; P <0.05). With regard to perforation rates, significant differences were also observed in relation to the location of the lesion (upper vs. middle vs. lower, 22.6 % vs. 2.8 % vs. 3.2 %; P <0.0005) and size of the lesion (> 20 mm vs. 20 mm or less, 16.2 % vs. 3.8 %; P <0.005). No local recurrences of curatively resected lesions (n = 119) were observed after a follow-up period of 1 year. Conclusions: The difficulty of ESD depends on the location and size of the lesion, as well as on the presence of ulceration. We would recommend that trainees should begin by carrying out ESD on lesions with a diameter of less than 20 mm without ulceration that are located in the lower third of the stomach.

AB - Background and study aims: Endoscopic submucosal dissection (ESD) is a new method for the curative treatment of early gastrointestinal neoplasms, which was developed in order to increase the en bloc and RO resection rate, especially for lesions larger than 20 mm in diameter. Drawbacks of ESD include the fact that it is technically a substantially more difficult procedure and that it is associated with a higher perforation rate. A retrospective study was therefore carried out to analyze cases in relation to the procedure time and resection success, and these factors were correlated with the characteristics of the lesions. Patients and methods: From January 2002 to November 2005, 196 lesions in 185 patients with early gastric cancer were treated using ESD in our hospital. The rates of curative en bloc resection, the incidence of perforation, and the procedure times were analyzed in relation to lesion size (small, 20 mm or less in diameter; large, over 20 mm), location (upper, middle, or lower third of the stomach) and the presence or absence of ulceration. Results: The rate of curative en bloc resection was 84 % (93 % of the lesions overall were resected in one piece), with a perforation rate of 6.1 % (all perforations were managed endoscopically) and a mean procedure time of 68 min. The rate of curative en bloc resection differed significantly depending on the location of the lesion (upper vs. middle vs. lower, 74 % vs. 77 % vs. 91 %; P<0.05), as well as on the size of the lesion (> 20 mm vs. 20 mm or less, 59 % vs. 89%; P 20 mm vs. 20 mm or less, 124 min vs. 55 min; P<0.0001), as well as the presence of ulceration (positive vs. negative, 97 min vs. 65 min; P <0.05). With regard to perforation rates, significant differences were also observed in relation to the location of the lesion (upper vs. middle vs. lower, 22.6 % vs. 2.8 % vs. 3.2 %; P <0.0005) and size of the lesion (> 20 mm vs. 20 mm or less, 16.2 % vs. 3.8 %; P <0.005). No local recurrences of curatively resected lesions (n = 119) were observed after a follow-up period of 1 year. Conclusions: The difficulty of ESD depends on the location and size of the lesion, as well as on the presence of ulceration. We would recommend that trainees should begin by carrying out ESD on lesions with a diameter of less than 20 mm without ulceration that are located in the lower third of the stomach.

UR - http://www.scopus.com/inward/record.url?scp=33750368325&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750368325&partnerID=8YFLogxK

U2 - 10.1055/s-2006-944716

DO - 10.1055/s-2006-944716

M3 - Article

C2 - 17058162

AN - SCOPUS:33750368325

VL - 38

SP - 987

EP - 990

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 10

ER -