Article Text

other Versions

Download PDFPDF
Endoscopic submucosal dissection for early gastric cancer: a large-scale follow-up study
  1. Hajime Isomoto (hajimei2002{at}
  1. Nagasaki University, Japan


    Objects: 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. We conducted a follow-up study on tumor recurrence and survival after ESD.

    Design: ESD was performed for patients with EGC that fulfilled the expanded criteria.

    Setting: The criteria for ESD were: mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings ≤3 cm in diameter; and minute submucosal invasive cancer ≤3 cm in size.

    Patients: 551 patients with 589 EGC lesions were enrolled.

    Intervention: The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6 to 89 months (median, 30 months).

    Main outcome measures: Resectability (en bloc or piecemeal resection), curability (curative or non-curative), and complications were assessed, and factors related to each were analyzed 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 tumor 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.

    Linked Articles

    • Digest
      Robin Spiller Magnus Simren