Background : Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods : We reviewed all patients with EGC who underwent ESD using the IT knife at Results : During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions ( ≥ 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10-540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment.Conclusion : The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC.

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The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms.

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BackgroundCapillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms.MethodsA series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI.ResultsThere were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 μm) from pSM2-3 (≥1000 μm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: κ = 0.68, 0.67, 0.72. Intraobserver agreement: κ = 0.79, 0.76, 0.75ConclusionIdentification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.

It technically was easier and as safe to perform EMR of colorectal LSTs when using glycerol as the submucosal injection solution.

Surgery remains the standard treatment after non-curative ER in patients with a possible risk of LNM.