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Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group

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Abstract

Background

Treatment with endoscopic submucosal dissection (ESD) for gastric noninvasive neoplasia (NIN) diagnosed by endoscopic forceps biopsy specimen, whether as a follow-up or “total incisional biopsy”, is controversial. To validate the use of ESD for total incisional biopsy in NIN, we examined the underdiagnosis rate of NIN and the rates of complication associated with ESD.

Methods

This is a cross-sectional multicenter retrospective study from 10 hospitals. Subjects diagnosed with NIN (equivalent to category 3 or 4.1 of the Vienna classification) by endoscopic forceps biopsy and treated with ESD were included. From March 2003 to December 2009, a total of 468 subjects were included and analyzed. The underdiagnosis rate was defined as the proportion of lesions diagnosed with adenocarcinoma after ESD. We assessed the complete en-bloc resection rate and the complication rate of ESD.

Results

Among the 468 subjects with NIN, 205 were diagnosed with adenocarcinoma after ESD, with an underdiagnosis rate of 44% (95% confidence interval: 39–49%). Two submucosal cancer lesions had invaded beyond 500 μm and one had lymphatic involvement. The complete en-bloc resection rate was 97%. The incidences of post-ESD bleeding, perforation, and serious complications were 5.5, 4.7, and 0.43%, respectively. There were no procedure-related deaths.

Conclusions

In this large-scale, multicenter cross-sectional study, over 40% of the noninvasive gastric neoplasia specimens were determined to have adenocarcinoma, and the ESD-related complication rate was relatively low. Therefore, ESD was useful and may be a therapeutic option for gastric NIN.

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Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

NBI:

Narrow band imaging

NIN:

Noninvasive neoplasia

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Acknowledgments

Study investigators: Yoshito Hayashi, Shunsuke Yamamoto, Tomofumi Akasaka, and Hideharu Ogiyma (Osaka University Hospital); Mamoru Yura (Minoh City Hospital); Masanori Nakahara and Yasushi Matsumoto (Ikeda Municipal Hospital); and Takamasa Yabuta (Sakai Municipal Hospital).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Clinical Research Building (K1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Motohiko Kato, Tsutomu Nishida, Shusaku Tsutsui, Takuya Yamada, Hideki Iijima, Masahiko Tsujii & Norio Hayashi

  2. Department of Gastroenterology, Kansai Rosai Hospital, Hyogo, Japan

    Masato Komori & Norio Hayashi

  3. Department of Gastroenterology, Osaka Kosei-Nenkin Hospital, Osaka, Japan

    Tomoki Michida

  4. Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan

    Katsumi Yamamoto

  5. Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan

    Naoki Kawai

  6. Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan

    Shinji Kitamura

  7. Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan

    Shinichiro Zushi

  8. Department of Gastroenterology, Minoh City Hospital, Minoh, Japan

    Akihiro Nishihara

  9. Department of Gastroenterology, Osaka Minami Medical Center, National Hospital Organization, Osaka, Japan

    Fumihiko Nakanishi

  10. Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan

    Kazuo Kinoshita

Authors
  1. Motohiko Kato
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  2. Tsutomu Nishida
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  3. Shusaku Tsutsui
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  4. Masato Komori
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  5. Tomoki Michida
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  6. Katsumi Yamamoto
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  7. Naoki Kawai
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  8. Shinji Kitamura
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  9. Shinichiro Zushi
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  10. Akihiro Nishihara
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  11. Fumihiko Nakanishi
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  12. Kazuo Kinoshita
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  13. Takuya Yamada
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  14. Hideki Iijima
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  15. Masahiko Tsujii
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  16. Norio Hayashi
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Corresponding author

Correspondence to Motohiko Kato.

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Kato, M., Nishida, T., Tsutsui, S. et al. Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group. J Gastroenterol 46, 325–331 (2011). https://doi.org/10.1007/s00535-010-0350-1

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  • DOI: https://doi.org/10.1007/s00535-010-0350-1

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