Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success

Imagawa, Atsushi; Okada, Hiroyuki; Kawahara, Yoshiro; Takenaka, Ryuta; Kato, Jun; Kawamoto, Hirofumi; Fujiki, Shigeatsu; Takata, Rie; Yoshino, Tomoyuki; Shiratori, Yasushi

doi:10.1055/s-2006-944716

Cited by 257 publications

(229 citation statements)

References 11 publications

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“…According to a recent meta-analysis, although ESD had higher en bloc and curative resection rates than endoscopic mucosal resection (EMR), operation time was longer, with higher risks of complications compared to EMR [7] . Previous reports showed that large tumor size, location of the lesion in an upper region of the stomach, and long procedure time are risk factors for perforation following ESD [8][9][10][11][12][13] . 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] .…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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AIM:To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS:We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography. RESULTS:Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION:Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air. Key words: Gastric cancer; Endoscopic submucosal dissection; Perforation; Risk factors; Treatment outcome Core tip: There has been little prospective study on the clinical outcomes of endoscopic perforation in endoscopic submucosal dissection for gastric neoplasia. In the current study, we investigated clinical outcomes of perforation during gastric endoscopic submucosal dissection, and analyzed various demographic and clinical parameters for risk factors. The results clearly demonstrated that prolonged procedure time (≥ 115 min),

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

View full text Add to dashboard Cite

show abstract

“…Endoscopic submucosal dissection (ESD) is an established treatment method in Japan that does not rely on snare techniques for the dissection of submucosal tissue and allows en-bloc resection of even large EGCs [2][3][4][5][6]. Moreover, submucosal tissue can be resected with sufficient vertical distance from the muscularis mucosae.…”

Section: Introductionmentioning

confidence: 99%

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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“…23 This is much lower than with ESD (1-6%). [24][25][26] Moreover, it is noteworthy that there was no significant difference regarding the recurrence rate in the APC groups, on an outpatient and admission basis. In addition, no complication was observed in both groups.…”

Section: 21mentioning

confidence: 86%

The Usefulness of Argon Plasma Coagulation Compared with Endoscopic Submucosal Dissection to Treat Gastric Adenoma

Lee

Bae

Kim

et al. 2017

Korean J Gastroenterol

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Background/Aims: To date, the best therapeutic modality for gastric adenoma, especially low-grade adenoma, has not been established. The aim of this study was to assess the usefulness of argon plasma coagulation (APC) in treating gastric adenoma compared with endoscopic submucosal dissection (ESD). Methods: We included 210 patients with gastric adenoma, who underwent treatment with either APC (97 patients) or ESD (113 patients). The clinical and pathologic characteristics, mean duration of hospital stay, complications, and recurrence rates between the two groups were compared. Results: The mean adenoma size was 0.9 cm and 1.1 cm in the APC group and ESD group, respectively (p<0.001). The mean duration of hospital stay was significantly shorter in the APC group than in the ESD group (1.6 days vs. 5.8 days, p<0.001). Complications did not occur in the APC group. However, one case of perforation (0.9%) and 6 cases of bleeding (5.3%) occurred in the ESD group. The recurrence rates were 15.3% (15/97 patients) in the APC group and 3.5% (4/113 patients) in the ESD group (p=0.003). The proportion of hospitalization was less in the APC group (43.3%, 42/97) than in the ESD group (100.0%, 113/113) (p<0.001). Medical expense was less in the APC group (377,172 won) than in the ESD group (1,430,610 won) (p<0.001). Conclusions: The findings of this study suggest that APC is a safe treatment method for gastric adenoma without serious complications. However, regular endoscopic follow-up is necessary to detect any residual or recurrent lesions due to the relatively high rate of local recurrence after APC. (Korean J Gastroenterol 2017;69:283-290)

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Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success

Cited by 257 publications

References 11 publications

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

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

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

The Usefulness of Argon Plasma Coagulation Compared with Endoscopic Submucosal Dissection to Treat Gastric Adenoma

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