A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

Abstract

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Predictors of early and late mortality after the treatment for early gastric cancers

“…5 Therefore, all-cause mortality is the most significant outcome for patients with EGCs. 6 Regarding predictors of all-cause mortality in patients with EGCs, several issues remain to be resolved. First, it is unclear how much the risk categories of LNM affect allcause mortality.…”

Non-Curative Resection: Should Clinicians Consider Providing Additional Surgery for All Patients?

“…1 It is surprising that the overall survival (OS) rate in patients with NCR without additional treatment in this study (98.9% at 5 years) was much higher than those in previous reports (72.0%-85.0%). 4 Although the reason for this is unclear, younger age (mean, 62.5 years) might have contributed to the high OS rate in this study.…”

Safe and economical use of hemostatic forceps for dissecting fibrosis or vessels during endoscopic submucosal dissection

“…Endoscopic submucosal dissection (ESD) is a well-established therapeutic strategy for resecting early gastrointestinal neoplasms 1 2 3 . However, operators sometimes encounter difficult situations during ESD, resulting in longer procedure times and an increasing complication rate.…”