Factors related to the curability of early gastric cancer with endoscopic submucosal dissection

Ohnita, Ken; Isomoto, Hajime; Yamaguchi, Naoyuki; Fukuda, Eiichiro; Nakamura, Takashi; Nishiyama, Hitoshi; Mizuta, Yohei; Akiyama, Motohisa; Kohno, Shigeru; Shikuwa, Saburo

doi:10.1007/s00464-009-0473-8

Cited by 40 publications

(41 citation statements)

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“…Similarly, Oda et al [16] reported that tumor location in the upper or middle third of the stomach, tumor size [21 mm, and ulceration were each associated with piecemeal resection of ECG, affecting curability by ESD. In addition, Ohnita et al [17] showed by multivariate analysis that ulceration is a primary cause of incomplete resection of EGC by ESD. Moreover, ulceration significantly increases the time required for the operation and is a risk factor for perforation [16,26,27], although it is not a cause of postoperative bleeding [16,28].…”

Section: Discussionmentioning

confidence: 99%

“…Submucosal dissection of F2 lesions is difficult because maintaining an appropriate dissection depth requires skill. Overly shallow dissection performed to avoid perforation may cause heat denaturation of the excised specimen, making detailed histopathological examination of the sample difficult and thus hindering clinical judgment [16,17,29].…”

Section: Discussionmentioning

confidence: 99%

“…The ESD procedure allows precise histological assessment of the resected specimen and prevents residual disease and local recurrence [2,[12][13][14]. Despite the success of ESD, incomplete resection has resulted when it has been applied to EGCs with ulceration [2,12,[15][16][17][18]. This difficulty raises the question of whether or to what extent additional clinicopathological factors, such as submucosal fibrosis, affect the outcome of ESD for EGC.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis

et al. 2012

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Background Whether submucosal fibrosis is related to ulceration and affects the outcome of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unknown. This study aimed to determine ESD outcome in relationship to degree of submucosal fibrosis of gastric epithelial neoplasms and to identify factors predictive of submucosal fibrosis. Methods Eight hundred ninety-one patients with 1,027 gastric epithelial neoplasms were treated by ESD from April 2005 to January 2011. Complete en bloc resection and perforation rates in relationship to degree of submucosal fibrosis (F0, no fibrosis; F1; mild fibrosis; F2, severe fibrosis) were determined during ESD, as well as degree of concordance between endoscopically observed ulceration and pathologically determined ulceration and pathological fibrosis stained with Masson's trichrome. Results The complete en bloc resection rate was significantly low and the perforation rate was high for F2 versus F0/F1 tumors. Ulceration, tumor size C30 mm, and depressed histological type were independent risk factors for severe (F2) fibrosis. No fibrosis (F0) was observed in 77 % (732/951) of endoscopically negative ulceration cases, whereas fibrosis was observed in 100 % (76/76) of endoscopically positive cases. Masson trichrome staining was weak in 97 % (710/732) of F0, moderate in 85 % (181/ 214) of F1, and strong in 100 % (81/81) of F2 cases. Conclusions Histopathological type of submucosal fibrosis predicts outcome of ESD for EGC. Endoscopic indications of F2 submucosal fibrosis are ulceration, tumor C30 mm, and macroscopic depression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis

et al. 2012

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“…However, the accuracy of T staging in EGC with ulcer is very low [14]. Third, the presence of ulceration interferes with complete resection and promotes a long procedure time and high risk of adverse events such as bleeding and perforation [3,[6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…However, improvement and exacerbation of ulceration repeat in patients with ulcerative EGC as a malignant cycle [5]. Moreover, EGC combined with ulcer is associated with a low curative resection rate and high risk of adverse events such as perforation and bleeding [3,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

et al. 2015

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Background In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. Methods A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. Results The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P \ 0.001). The procedure time was 38.1 ± 35.7 and 50.8 ± 50.2 min (P = 0.047). However, no significant differences were detected in the en bloc resection rate, complete resection rate, and adverse events including bleeding and perforation. Multivariate analysis showed that administration of PPI (OR = 10.83, P \ 0.001) and mucosal invasion (OR = 24.43, P \ 0.001) were independent factors that predicted complete healing of ulceration. The calculated accuracy for whether complete healing of the ulcer after PPI administration can differentiate mucosal from submucosal invasion was 75.3 %. Conclusions Administration of PPI before ESD in differentiated EGC meeting the expanded criteria is effective to heal the ulcer lesion and reduce the mean procedure time. Complete healing of the ulcer after PPI administration suggests mucosal cancer.

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Diagnostische und interventionelle Endoskopie in der Gastroenterologie

Hochberger

Kruse

Köhler

et al. 2009

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In the past 10 years endoscopic diagnostics has benefited from technologies such as big chips, high-definition television (HDTV) and narrow band imaging (NBI). Video capsule endoscopy and double balloon enteroscopy have facilitated visualization of the entire small bowel. A number of studies on mucosal Barrett's and gastric cancers could prove that endoscopic mucosal resection (EMR) is oncologically equivalent to surgical resection when certain criteria are respected. However, EMR is less invasive and carries a substantially lower complication risk and mortality compared to surgery. Endoscopic submucosal dissection (ESD) facilitates en bloc resection with thorough histopathologic evaluation of the specimen, e.g. for mucosal lesions in the stomach and rectum. Endosonography (EUS) guided transgastric necrosectomy using a flexible gastroscope has set a milestone in the treatment of infected pancreatic necroses and has replaced open surgery in many centers. Natural orifice transluminal endoscopic surgery (NOTES) uses natural body openings as minimally invasive access to the abdomen and mediastinum. Interventional GI endoscopists and minimally invasive surgeons have profited from these innovations in micromechanics and microelectronics.

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Factors related to the curability of early gastric cancer with endoscopic submucosal dissection

Abstract: When risk factors including positive ulcer findings and larger size and upper location of tumors are combined, ESD should be performed more carefully.

Cited by 40 publications

References 14 publications

Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis

Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Diagnostische und interventionelle Endoskopie in der Gastroenterologie

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