Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center

Abstract

OBJECTIVE:Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center.METHODS:We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher's exact test and chi-square tests, with 95% confidence intervals.RESULTS:In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with “only-by-size” expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014).CONCLUSION:These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.

Endoscopic submucosal dissection of gastric neoplastic lesions in Western countries: systematic review and meta-analysis

“…No further studies were identified among the 2610 citations available on Google Scholar. Therefore, data of 22 studies were eventually available [6–27]. In detail, there were 15 studies performed in Europe, six in Latina America, and one in Canada, with a total of 1152 patients (males: 52%; mean age: 68.5 years) and 1210 lesions, including 697 EGC, 484 dysplasia, 13 neuroendocrine tumor, and 16 with other lesions.…”

Short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries: a systematic review and meta-analysis

“…Twenty-six studies reported data on the en bloc resection rate of superficial gastric neoplasms (n=1811) [ 8 - 11 , 18 - 26 , 28 - 40 ]. En bloc resection was achieved in 96% overall (95%CI 0.94-0.98; I 2 =58%) ( Fig.…”

“…Fifteen studies reported data on the curative resection rate of superficial gastric neoplasms treated by ESD, including only adenocarcinoma histology (n=863) [ 8 , 9 , 11 , 18 , 24 , 26 , 28 - 30 , 32 , 35 - 39 ]. Curative resection including only adenocarcinoma histology was achieved in 75% overall (95%CI 0.70-0.80; I 2 =67%) ( Fig.…”