Background: Esophagogastric junction (EGJ) cancers are not only located in regions anatomically difficult for endoscopic submucosal dissection (ESD), but they also have higher clinicopathological malignant potential than non-junctional gastric cancers (NJC). Despite this, no ESD-based comparative studies of junctional cancer (JC) and NJC have been conducted to date. The aims of this study were to clarify the clinicopathological characteristics of EGJ cancers and the short- and long-term outcomes after ESD. Methods: Between April 2005 and December 2010, ESD was performed on 1,463 lesions that were divided into the following three groups: Barrett’s adenocarcinoma (BA; n = 25); JC (n = 103), and NJC (n = 1,335). They were assessed for short-term outcomes, clinicopathological malignancy and long-term outcomes. Results: Rates of complete and curative resection were significantly lower for BA than for JC and NJC (64.0 vs. 96.1 and 96.0%; and 48.0 vs. 80.6 and 85.8%, respectively). The perforation rate was significantly higher for BA than for JC and NJC (20.0 vs. 2.9 and 2.7%). Clinicopathologically, submucosal invasion rates were higher in BA and JC than in NJC (32.0 and 30.1 vs. 13.6%), and positive rates of lymphatic and/or vascular invasion were remarkably higher in BA and JC versus NJC (24.0 vs. 9.7 vs. 4.8%, respectively). The 5-year survival rate in all patients with curative resection was 100%. Conclusion: This study confirmed the technical and theoretical validity of ESD for EGJ as a diagnostic treatment. However, we have to pay attention to the high rates of submucosal and lymphovascular invasive malignant potential of these cancers.
Backgrounds. Magnifying endoscopy with narrow-band imaging (ME-NBI) has become essential for determining tumor margin in early gastric cancer (EGC). Here, we investigated the usefulness of ME-NBI for assessment of invasion depth in EGC.
Methods. For 119 patients who had undergone ME-NBI and en bloc resection by endoscopic submucosal dissection, three physicians prospectively examined high-magnification ME-NBI images for clinical features such as presence or absence of dilated vessels (D vessels). Cases with D vessels verified by at least two physicians were assigned to group V, and others were assigned to group N. We then compared clinicopathological factors associated with the groups. Results. Groups V and N consisted of 18 and 101 patients, respectively. There were no significant differences in age, gender, tumor size, tumor location, gross morphology, or histological type. The percentage of submucosal cancer was 9.9% (10/101) in group N and significantly higher at 33.3% (6/18) in group V (P = 0.007). When the presence of D vessels was considered a diagnostic criterion for submucosal cancer, diagnostic accuracy, sensitivity, and specificity were 81.5, 37.5, and 88.3%, respectively. Conclusions. The results suggest that identification of D vessels using ME-NBI can assist in the assessment of invasion depth in EGC.
Background/Aims: In endoscopic submucosal dissection (ESD), misdiagnosis of the tumor margin may lead to residual carcinoma, which we treat by secondary ESD (sESD) for local control. Methods: 1,458 lesions of early gastric carcinoma were treated by ESD between July 2006 and November 2011. 33 lesions were resected with positive lateral margins. Among them, 13 patients were treated by surgery, 12 patients were followed up, and 8 patients were treated by sESD. sESD was defined as resection of residual carcinoma surrounding the ulcer of primary ESD (pESD). Safety and efficacy of sESD were retrospectively evaluated. Results: Mean interval between two ESDs was 8.4 days. The mean specimen area was 14.9 cm2 in pESD and 23.9 cm2 in sESD. The mean procedure time was 107.3 and 193.0 min, and mean dissection area was 15.9 and 11.6 mm2/min, respectively. There were no significant differences and no serious complications occurred during sESD. There was no local recurrence after a mean follow-up period of 896 days. Meanwhile, 4 cases of local recurrence were detected after ESD with a positive lateral margin. Conclusion: The results suggest that sESD may be technically feasible and favorable for local control of residual gastric carcinoma.
Background. Intraoperative bleeding is an important determinant for safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to prospectively evaluate the usefulness of endoscopic ultrasound (EUS) for predicting ESD safety. Methods. A total of 110 patients with EGC were divided into two groups based on EUS findings: group P, almost no blood vessels in submucosa, or ≤4 small vessels per field of view; group R, remaining patients. Primary endpoint was the decrease in Hb after ESD. Secondary endpoints included procedure time and the incidence of muscle injury and clip use. Results. A total of 89 patients were evaluated. Fifty were classified into group P and 39 into group R. Mean decrease in Hb was 0.27 g/dL in group P and 0.35 g/dL in group R, with no significant difference. Mean procedure time was significantly longer in group R (105.4 min) than in group P (65.5 min) (P < 0.001). The incidence of muscle injury and clip use were significantly higher in group R (25.6%/48.7%) than in group P (8.0%/20.0%) (P = 0.02/P = 0.004). Conclusion. Preoperative EUS can predict procedure time and the incidence of muscle injury and clip use and is thus considered useful for predicting gastric ESD safety.
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