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Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study
  1. H Isomoto,
  2. S Shikuwa,
  3. N Yamaguchi,
  4. E Fukuda,
  5. K Ikeda,
  6. H Nishiyama,
  7. K Ohnita,
  8. Y Mizuta,
  9. J Shiozawa,
  10. S Kohno
  1. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
  1. Dr H Isomoto, Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; hajimei2002{at}yahoo.co.jp

Abstract

Objective: Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes remain unknown. A follow-up study on tumour recurrence and survival after ESD was conducted.

Method: ESD was performed for patients with EGC that fulfilled the expanded criteria: mucosal cancer without ulcer findings irrespective of tumour size; mucosal cancer with ulcer findings ⩽3 cm in diameter; and minute submucosal invasive cancer ⩽3 cm in size. 551 patients with 589 EGC lesions were enrolled. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6–89 months (median, 30 months). The main outcome measures were resectability (en bloc or piecemeal resection), and curability (curative or non-curative). Complications were assessed, and factors related to each were analysed statistically. The overall and disease-free survival rates were estimated.

Results: En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.

Conclusion: Precise assessment of curability with successful one-piece resection may reduce tumour recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.

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Footnotes

  • Competing interests: None.

  • Ethics approval: Ethical approval was obtained for this study and written informed consent was obtained from all patients before ESD.

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