Endoscopic mucosal resection for treatment of early gastric cancer

Abstract

Background-In Japan, endoscopic mucosal resection (EMR) is accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The results of EMR for EGC at the National Cancer Center Hospital, Tokyo, over a 11 year period are presented. Methods-EMR was applied to patients with early cancers up to 30 mm in diameter that were of a well or moderately histologically diVerentiated type, and were superficially elevated and/or depressed (types I, IIa, and IIc) but without ulceration or definite signs of submucosal invasion. The resected specimens were carefully examined by serial sections at 2 mm intervals, and if histopathology revealed submucosal invasion and/or vessel involvement or if the resection margin was not clear, surgery was recommended. Results-Four hundred and seventy nine cancers in 445 patients were treated by EMR from 1987 to 1998 but submucosal invasion was found on subsequent pathological examination in 74 tumours. Sixty nine percent of intramucosal cancers (278/ 405) were resected with a clear margin. Of 127 cancers without "complete resection", 14 underwent an additional operation and nine were treated endoscopically; the remainder had intensive follow up. Local recurrence in the stomach occurred in 17 lesions followed conservatively, in one lesion treated endoscopically, and in five lesions with complete resection. All tumours were diagnosed by follow up endoscopy and subsequently treated by surgery. There were no gastric cancer related deaths during a median follow up period of 38 months (3-120 months). Bleeding and perforation (5%) were two major complications of EMR but there were no treatment related deaths. Conclusion-In our experience, EMR allows us to perform less invasive treatment without sacrificing the possibility of cure. (Gut 2001;48:225-229)

Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

“…There were no perforation cases in this study. However, it is necessary to pay particular attention to perforations because Ohkuwa et al (1) and Ono et al (7) reported that the incidence of perforation with IT-ESD is 5%.…”

Preventive effects of etodolac, a selective cyclooxygenase‐2 inhibitor, on cancer development in extensive metaplastic gastritis, a Helicobacter pylori‐negative precancerous lesion

“…[21][22][23][24][25][26] All patients were inhabitants from around the Wakayama area. In Japan, where the incidence of gastric cancer is high, treatment of mucosal gastric cancer without lymph node metastasis is usually achieved with endoscopic resection, preserving the stomach.…”

Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

“…An insulation-tipped diathermic knife (IT knife) was developed as an endoscopic cutting instrument for ESD at the Endoscopy Division of the National Cancer Center in Tokyo [1][2][3]. An insulated small ceramic sphere connected to the tip of a high-frequency needle knife allows for safe and easy incision and separation of the mucosal and submucosal layers.…”