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ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIES
Author(s) -
Oda Ichiro,
Gotoda Takuji,
Hamanaka Hisanao,
Eguchi Takako,
Saito Yutaka,
Matsuda Takahisa,
Bhandari Pradeep,
Emura Fabian,
Saito Daizo,
Ono Hiroyuki
Publication year - 2005
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2005.00459.x
Subject(s) - medicine , perforation , endoscopic submucosal dissection , surgery , endoscopic mucosal resection , dissection (medical) , cancer , resection , endoscopy , materials science , punching , metallurgy
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 National Cancer Center Hospital in the period between January 2000 and December 2003. 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.