Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study

Abstract

Background/AimsEndoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs.MethodsA prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study group-related university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board.ResultsA patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-freeen bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations.ConclusionsESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in follow-up studies.

Endoscopic submucosal dissection in the West: Current status and future directions

“…Delayed bleeding rate was 6%, and perforation rate was 1% . In comparison, large multicenter studies of ESD for EGC at major Eastern institutions report similar en bloc resection rates of 92.7–96.1% and R0 resection rates of 82.6–94.5%, with bleeding rates of 0.6–9.9% and perforation rates of 3.6–4.7% …”

Short‐term outcomes of multicenter prospective cohort study of gastric endoscopic resection: ‘Real‐world evidence’ in Japan

“…The J‐WEB/EGC study is the first multicenter prospective study conducted in the context of ‘real‐world’ settings to demonstrate a favorable short‐term outcome for gastric ER (mostly ESD) among a large number of EGC lesions based on all categories of the absolute and expanded indications . There are a number of published reports on the short‐term and long‐term outcomes of ESD for EGC, but most of the reports are retrospective studies from single centers . There were two multicenter prospective studies about the clinical outcomes of ESD for EGC; however, these multicenter prospective studies did not include all EGC lesions meeting the absolute and expanded indications .…”

“…There are a number of published reports on the short‐term and long‐term outcomes of ESD for EGC, but most of the reports are retrospective studies from single centers . There were two multicenter prospective studies about the clinical outcomes of ESD for EGC; however, these multicenter prospective studies did not include all EGC lesions meeting the absolute and expanded indications . In this situation, to overcome these limitations, a Japanese multicenter prospective cohort study of ER for EGC using a Web registry system (J‐WEB/EGC) was developed and introduced in July 2010 .…”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] There were two multicenter prospective studies about the clinical outcomes of ESD for EGC; however, these multicenter prospective studies did not include all EGC lesions meeting the absolute and expanded indications. 23,24 In this situation, to overcome these limitations, a Japanese multicenter prospective cohort study of ER for EGC using a Web registry system (J-WEB/EGC) was developed and introduced in July 2010. 25 In this report, the short-term outcomes of ER for EGC, such as the ER procedural outcomes, the factors associated with a long ER procedure time, and the clinical outcomes of noncurative gastric ER cases, were precisely evaluated by collecting an enormous amount of data from a very large number of EGC cases according to the common terminology criteria defined in the study protocol.…”

“…Recently, a number of reports have been published regarding the short‐term and long‐term outcomes of EMR and ESD for EGC, but most of these reports were retrospective studies from single centers . A Japanese multicenter prospective cohort study of ER for EGC using a Web registry system (J‐WEB/EGC) has been conducted to determine the short‐term and long‐term outcomes based on the absolute and expanded indications .…”