Endoscopic Submucosal Dissection for Early Gastric Cancer: Technical Feasibility, Operation Time and Complications From a Large Consecutive Series

Abstract

Background : Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods : We reviewed all patients with EGC who underwent ESD using the IT knife at Results : During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions ( ≥ 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10-540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment.Conclusion : The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC.

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

“…These studies found that the local recurrence rate was significantly higher for EMR than for ESD in patients treated at a single center. Multicenter clinical trials have also shown that ESD has lower rates of local residual tumor and recurrence than EMR [15]. Tada et al [1] reported local recurrence in 6 (6.9 %) of 87 patients with early gastric cancer who underwent EMR by strip biopsy.…”

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

“…Especially, endoscopic submucosal dissection (ESD) allows en bloc resection with tumor-free margins, even in cases with large and ulcerative lesions [1,2]. According to previous reports, the complete en bloc resection rate of ESD was over 80 %, which was significantly higher than that of conventional endoscopic mucosal resection [3].…”

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

“…Indeed, only 8 of the patients in our study had perforation. In reports from Japan and South Korea, perforation was observed in 1.2% to 6.1% of patients [8][9][10][11][12][13][14][15] . Our perforation rate (8.2%) was slightly higher than in the other studies.…”

“…Although perforation may be the most serious complication in the ESD procedure, most studies have reported recovery from perforation with conservative management such as endoscopic clipping, fasting, nasogastric aspiration, and broad-spectrum antibiotics [1,14] . However, the previous reports regarding clinical outcomes of perforation during ESD are retrospective analyses [5,8,9,[13][14][15] . More recently, prospective studies by Onogi et al [16] and our group [17] found that "transmural air leak" or "silent" free air without endoscopically visible perforation detected only by computed tomography (CT) did not affect the post-ESD clinical course.…”