Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study

Isomoto, Hajime; Shikuwa, Saburo; Yamaguchi, Naoyuki; Fukuda, Eiichiro; Ikeda, Kohki; Nishiyama, Hitoshi; Ohnita, Ken; Mizuta, Yohei; Shiozawa, Junichi; Kohno, Shigeru

doi:10.1136/gut.2008.165381

Cited by 604 publications

(542 citation statements)

References 18 publications

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“…However, the prognosis in patients with SM-GCs treated by ESD remains unspecified, and the actual feasibility of ESD for SM-GCs remains controversial. To our knowledge, although outcomes of EGCs resected by ESD have been reported [10][11][12][13][14][15][16][17], there are no reported comparisons between SM1-GC and SM2-GC. Therefore, we studied outcomes in patients with SM-GCs treated by ESD to determine the feasibility of the procedure across classifications.…”

Section: Introductionmentioning

confidence: 92%

“…Thus, examining the submucosal invasive portion is quite important for predicting lymph node metastasis. In reporting outcomes of ESD for EGCs [10][11][12][13][14][15][16][17], Goto et al [10] noted 5-year overall and disease-specific survival rates of 96.2 and 100%, respectively, with neither lymph node metastasis nor other-organ metastasis. Gotoda et al [11] found no significant difference in overall survival between EGCs that met the guideline criteria and those that met the expanded criteria.…”

Section: Discussionmentioning

confidence: 99%

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Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

et al. 2011

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Background The 2010 Japanese Gastric Cancer Association guidelines for the treatment of submucosal invasive gastric cancer (SM-GC) specify size 30 mm or less, differentiated-dominant histology, lack of vessel involvement, and submucosal invasion of less than 500 lm (SM1) as expanded criteria for curative endoscopic resection. Our purpose in this study was to confirm the validity of the expanded indications for curative endoscopic submucosal dissection (ESD) of SM-GC. Methods The study subjects were 173 patients with SM-GC resected by ESD at Hiroshima University Hospital between April 2002 and September 2010, including 99 patients for whom 3-plus years' follow-up information was available. Post-ESD outcomes were compared between cases of SM1-GC that met the expanded ESD criteria, those that did not, and SM2-GC cases.Results Complete resection was achieved for 93.2% of the SM1-GCs that met the expanded criteria. There was neither metastasis to lymph nodes or other organs nor local recurrence among the SM1-GCs. Disease-specific survival did not differ significantly between patients that were simply followed up after ESD and those that were treated by additional surgical resection. Conclusions Our outcome data support the clinical validity of ESD without additional surgical resection for SM1-GCs that meet the expanded criteria.

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Section: Introductionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

et al. 2011

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“…prognosis and less surgical trauma [7][8][9]. The 5-year survival rate in advanced gastric cancer patients is very low, even after surgery-predominant combined treatment, and the survival rate of gastric cancer patients in Western countries is only 20-30 % [10,11].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Comparison of the diagnostic efficacy of white light endoscopy and magnifying endoscopy with narrow band imaging for early gastric cancer: a meta-analysis

et al. 2015

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Objective Magnifying endoscopy with narrow band imaging (ME-NBI) is widely used in gastroscopy, especially in the diagnosis of early gastric cancer. The purpose of this meta-analysis is to compare the diagnostic efficacy of white light imaging (WLI) and that of ME-NBI for early gastric cancer. Methods PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched to identify studies which met the inclusion criteria. A random-effects model was used to calculate overall sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) to assess the diagnostic efficacy of WLI and ME-NBI in early gastric cancer. Sensitivity analysis was performed to assess the stability of the results. Results Ten studies met the inclusion criteria, and included 1724 patients and 2153 lesions. The pooled sensitivity, specificity, and AUC for the diagnosis of early gastric cancer using WLI were 0.48 [95 % confidence interval (CI) 0.39-0.57; I 2 = 78.6 %], 0.67 (95 % CI 0.62-0.71; I 2 = 81.9 %), and 0.62, respectively. The pooled sensitivity, specificity, and AUC using ME-NBI were 0.83 (95 % CI 0.79-0.87; I 2 = 79.8 %), 0.96 (95 % CI 0.95-0.97; I 2 = 89.3 %), and 0.96, respectively. The studies showed a high degree of heterogeneity. Further sensitivity analysis was mainly performed for the studies of small lesions (mean size 10 mm or less) and the studies with a the score of 12 points or greater in the literature quality assessment, and the AUCs for ME-NBI for diagnosis of early gastric cancer were between 0.93 and 0.98, which suggested that the diagnostic value was still high and stable. Conclusion Compared with WLI, ME-NBI can effectively diagnose early gastric cancer.

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“…1Endoscopic resection, including endoscopic submucosal dissection (ESD), is currently accepted widely as an effective, minimally invasive local treatment for early gastric cancer with a negligible risk of lymph node metastasis, delivering a favorable long-term outcome [1][2][3][4][5][6][7]. However, the development of metachronous gastric cancer (MGC), owing to the preservation of the entire stomach after endoscopic resection, remains a possibility [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

Mori

Nakajima

Asada³

et al. 2015

Gastric Cancer

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Background A previous multicenter prospective randomized study from Japan showed that Helicobacter pylori eradication reduced the development of metachronous gastric cancer (MGC) after endoscopic resection for early gastric cancer. MGC risk, however, is not eliminated; yet few studies have evaluated its long-term incidence and risk factors. In this study, we investigated the incidence of and risk factors for MGC in patients who underwent endoscopic resection for early gastric cancer with successful H. pylori eradication. Methods A total of 594 patients who underwent endoscopic resection for early gastric cancer and successful H. pylori eradication at three institutions (National Cancer Center Hospital, University of Tokyo Hospital, and Wakayama Medical University Hospital) were analyzed retrospectively. Annual endoscopic surveillance was performed after initial endoscopic resection. MGC was defined as a gastric cancer newly detected at least 1 year after successful H. pylori eradication. Results Ninety-four MGCs were detected in 79 patients during the 4.5-year median follow-up period. KaplanMeier analysis showed the cumulative incidence of MGC 5 years after successful H. pylori eradication was 15.0 %; the incidence of MGC calculated by use of the person-year method was 29.9 cases per 1000 person-years. Multivariate analysis using the Cox proportional hazards model revealed that male sex, severe gastric mucosal atrophy, and multiple gastric cancers before successful H. pylori eradication were independent risk factors for MGC. Eleven percent of MGCs (10 of 94) were detected more than 5 years after successful H. pylori eradication. Conclusion Surveillance endoscopy for MGC in patients who have undergone endoscopic resection for early gastric cancer should be performed even after successful H. pylori eradication.

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Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study

Abstract: Precise assessment of curability with successful one-piece resection may reduce tumour recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.

Cited by 604 publications

References 18 publications

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Comparison of the diagnostic efficacy of white light endoscopy and magnifying endoscopy with narrow band imaging for early gastric cancer: a meta-analysis

Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

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