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

Kim, Sang Gyun; Park, Chan Mi; Lee, Na Rae; Kim, Jiyoung; Lyu, Da Hyun; Park, Seunghee; Choi, Il Ju; Lee, Wan Sik; Park, Seun Ja; Kim, Jae Jun; Kim, Ji Hyun; Lim, Chul-Hee; Cho, Joo Young; Kim, Gwang Ha; Lee, Yong Chan; Jung, Hwoon Yong; Lee, Jun Haeng; Chun, Hoon Jai; Seol, Sang Yong

doi:10.5009/gnl17414

Cited by 57 publications

(41 citation statements)

References 15 publications

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“…ESD was developed to achieve en bloc resection of larger tumors in the stomach and has been accepted as standard treatment for early gastric cancer with minimal risk of lymph node metastasis [11,12]. Recent studies of the efficacy of ESD for the treatment of SNDA report high en bloc and complete resection rates of up to 80-100% [13][14][15][16], In this study, the en bloc anc complere resection rates were 90.0 and 80.0%, which is similar to the previous studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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Background and Aims: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). Methods: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose followup period was > 12 months > 1 year. Results: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n = 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12-137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. Conclusions: Favorable longterm outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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“…49 A Korean multicenter prospective study published in 2018 reported the incidence of local recurrence to be 0.7% in patients who had curative ESD and 2.4% who had non-curative ESD. 188 Thus, since the incidence of local recurrence following curative ESD is below 1%, detecting synchronous or metachronous gastric cancer must be prioritized before detecting local recurrences. Since patients with early gastric cancer who receive endoscopic resection have most of their gastric mucosa intact, they are more prone to developing metachronous and synchronous gastric cancers compared with those after surgical gastrectomy.…”

Section: Statement G12: We Recommend Regular Surveillance Endoscopy Ementioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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“…Confirmatory data on the role of endoscopic submucosal dissection (ESD) in patients with early GC were published in the last year. In a Korean prospective multicenter study by Kim et al , 697 patients with early GC who met the absolute and extended criteria and underwent ESD were followed for 5 years. Only selected centers performing a minimum of 20 ESD per year took part to this study.…”

Section: Gastric Cancer: Treatmentmentioning

confidence: 99%

Gastric cancer: epidemiology, prevention, and therapy

et al. 2018

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Gastric cancer (GC) is still the third leading cause of cancer death in both sexes worldwide. Helicobacter pylori infection is the most important risk factor for GC and, in spite of the consistent trend of a decreasing incidence, in 2015 approximately 4.4 billion individuals-more than half the world's population-were infected with H. pylori. The birth cohort pattern of decreased H. pylori infection reported in a systematic review contributes to explain the declining GC mortality in Japan. Current trends in estimated annual percentage change of GC incidence foreshadow expected reversals in both falling incidence and male predominance among US non-Hispanic whites. Combining serum pepsinogen 1 and H. pylori serology was shown to be useful for GC risk stratification in a Finnish population. Gastritis staging by operative link on gastritis assessment was confirmed to be reliable in predicting GC risk in a large prospective study. In a randomized trial from South Korea, H. pylori eradication therapy significantly reduced the rates of metachronous GC in patients who received curative endoscopic resection for early GC. A study based on a territory-wide health care database of the Hong Kong Hospital Authority showed that aspirin use is associated with a reduced GC risk. Another study based on the same database showed that proton pump inhibitors increase GC risk, but methodological biases have most likely acted as confounders. Confirmatory data on the role of endoscopic submucosal dissection in patients with early GC have been published. The phase III FLOT4 trial has shown that the FLOT triplet regimen (docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil) improves the outcome of patients with GC and locoregional disease as compared to the ECF triplet (epirubicin, cisplatin, and 5-fluorouracil). In the phase III ATTRACTION-2 trial, nivolumab was shown to be an effective treatment option with a relative safe profile for heavily pretreated patients with advanced GC.

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

Cited by 57 publications

References 15 publications

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Gastric cancer: epidemiology, prevention, and therapy

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