Elsevier

Gastrointestinal Endoscopy

Volume 50, Issue 6, December 1999, Pages 819-822
Gastrointestinal Endoscopy

Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer,☆☆

https://doi.org/10.1016/S0016-5107(99)70165-3Get rights and content

Abstract

Background: Several techniques are available for the endoscopic treatment of gastric intramucosal cancers, but their advantages and disadvantages have not been adequately evaluated. We compared the therapeutic usefulness of endoscopic aspiration mucosectomy with that of strip biopsy. Methods: Between May 1995 and May 1997, we performed strip biopsy (May 1995 through February 1996) or endoscopic aspiration mucosectomy (March 1996 through May 1997) in a consecutive series of patients with intestinal-type intramucosal cancer. Parameters of assessment included the following: size of removed specimens, en bloc resection rate, time required for resection, duration of hospitalization, and complications. Results: Forty-nine patients with gastric intramucosal cancers underwent endoscopic aspiration mucosectomy and 44 underwent strip biopsy. The two groups were similar with respect to age, gender, and lesion macroscopic appearance, size, and site. The mean longest diameter of the resected specimens was significantly greater with endoscopic aspiration mucosectomy (20.3 ± 3.4 mm) than with strip biopsy (15.8 ± 4.4 mm) (p < 0.001). The rate of en bloc resection (resection of an entire lesion in one procedure) was significantly higher with endoscopic aspiration mucosectomy (61.2%, 30 of 49) than with strip biopsy (36.4%, 16 of 44) (p < 0.05). The number of specimens obtained by piecemeal resection was slightly, but not significantly, higher with strip biopsy (2.4 ± 1.7) than with endoscopic aspiration mucosectomy (2.0 ± 1.7). The time required for treatment was similar for each procedure. The duration of hospitalization was significantly shorter with endoscopic aspiration mucosectomy (12.8 ± 5.3 days) than with strip biopsy (15.9 ± 74 days) (p < 0.05). As for complications, the rate of bleeding was 20.5% (9 of 44) with strip biopsy and 10.2% (5 of 49) with endoscopic aspiration mucosectomy; bleeding was controlled in all cases by treatment with a heater probe. Conclusions: Endoscopic resection of large gastric intramucosal tumors is easier with endoscopic aspiration mucosectomy compared with strip biopsy. Endoscopic aspiration mucosectomy is a useful procedure for en bloc resection. (Gastrointest Endosc 1999;50:819-22.)

Section snippets

PATIENTS AND METHODS

We compared the results of strip biopsy in 44 consecutive patients who underwent the procedure between May 1995 and February 1996 with the results in 49 consecutive patients who underwent EAM between March 1996 and May 1997. Patients with intestinal-type intramucosal cancer of the stomach were eligible for enrollment.

EAM was performed as described by Torii et al.5 Briefly, the lesion margin was marked with a heater probe (Olympus Optical Co., Ltd., Tokyo, Japan). Physiologic saline solution was

RESULTS

The demographic characteristics of the two groups of patients are shown in Table 1.

. Demographic characteristics of patients

Empty CellStrip biopsy (n = 44)EAM (n = 49)p Value
Gender (male/female)31/1338/11NS
Age (yr) (mean ± SD)64.4 ± 9.163.9 ± 9.8NS
Macroscopic appearance
 I20
 IIa2224NS
 IIc2025
CMA classification
 C89
 M1620NS
 A2020
Longest diameter of lesion (mm)
 Less than 102516
 10 to 19.91529NS
 20 to 29.943
 30 or greater01

NS , Not significant.

The groups were similar with respect to age, gender, and lesion macroscopic

DISCUSSION

Endoscopic mucosal resection (EMR) is becoming a widely accepted treatment of early gastric cancer. Endoscopic treatment is now considered a viable option in GI oncology, and its therapeutic efficacy, including benefits with respect to patients’ quality of life, is being evaluated by many centers. Various techniques are used to perform EMR,1, 2, 3, 4 strip biopsy being the most widely used. Strip biopsy is considered useful for diagnosis as well as treatment.1, 7 We have used strip biopsy since

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Reprint requests: Satoshi Tanabe, MD, Department of Internal Medicine, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara City, Kanagawa 228-8555, Japan.

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