Article Text

Download PDFPDF
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}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

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

Linked Articles

  • Digest
    Robin Spiller Magnus Simren