Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group

Kato, Motohiko; Nishida, Tsutomu; Tsutsui, Shusaku; Komori, Masato; Michida, Tomoki; Yamamoto, Katsumi; Kawai, Naoki; Kitamura, Shinji; Zushi, Shinichiro; Nishihara, Akihiro; Nakanishi, Fumihiko; Kinoshita, Kazuo; Yamada, Takuya; Iijima, Hideki; Tsujii, Masahiko; Hayashi, Norio

doi:10.1007/s00535-010-0350-1

Cited by 96 publications

(81 citation statements)

References 18 publications

(33 reference statements)

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“…The depressed type is also reported to have more malignant potential. We, however, revealed that even patients with both smaller and elevated neoplasms had a greater than 40% under-diagnosis rate [27] . Similarly, cancer foci have been reported in hyperplastic polyps with a diameter of 5 mm [31] .…”

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confidence: 62%

“…We recently reported that the underdiagnosis rate of intraepithelial neoplasia proven by biopsy was 44% (95% CI: 39%-49%). Moreover, in that study, there were 2 lesions (0.42%) of adenocarcinoma with submucosal invasion of more than 500 μm, one of which involved the lymphatic system [27] . The reasons for the difficulty in making an accurate diagnosis based on a biopsy specimen are as follows: (1)the structural atypia of both adenoma and well-differentiated adenocarcinoma is too subtle to detect in small biopsy specimens; (2) cancer sometimes exists focally in the lesion and a sampling error might occur; and (3) regeneration of atypia induced by gastritis induces histological modification (Figure 1).…”

Section: Difficulty Of Accurate Diagnosis Based On Biopsymentioning

confidence: 77%

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Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

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Treatment strategies, whether as follow-up or "total incisional biopsy" for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and highfrequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

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confidence: 62%

Section: Difficulty Of Accurate Diagnosis Based On Biopsymentioning

confidence: 77%

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

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“…Endoscopic submucosal dissection (ESD) for ESCNs is an endoluminal therapeutic technique to dissect directly along the submucosal layer. ESD was developed in Japan for the surgical treatment of gastric cancer and gave high curative resection rates for early gastric cancer, regardless of tumor size [18][19][20][21][22][23] . Hence, the technique has also been introduced for the esophagus [24] and was approved for the treatment of esophageal cancer by the Japanese government in 2008.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Honda

Akiho

2012

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Endoscopic resection is an effective treatment for noninvasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation.Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

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“…We thank Dr. László Czakó et al for their letter and interest regarding our article [1]. Dr. Czakó et al made the following points concerning the strategy for treating gastric non-invasive neoplasia (NIN): (1) gastric NIN should be endoscopically resected; (2) concerning the modality of the treatment, endoscopic mucosal resection (EMR) may be recommended for the removal of small (\5 mm), elevated lesions, and endoscopic submucosal dissection (ESD) would be preferred for larger or depressed lesions.…”

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Reply to the letter by L. Czakó et al. regarding “Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group”

2012

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Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group

Abstract: In this large-scale, multicenter cross-sectional study, over 40% of the noninvasive gastric neoplasia specimens were determined to have adenocarcinoma, and the ESD-related complication rate was relatively low. Therefore, ESD was useful and may be a therapeutic option for gastric NIN.

Cited by 96 publications

References 18 publications

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Reply to the letter by L. Czakó et al. regarding “Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group”

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