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Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer.
Gastrointest Endosc 2006; 64(6):877-83GE

Abstract

BACKGROUND

In EMR of early gastric cancer (EGC), en bloc resection reduces the risk of residual cancer. Endoscopic submucosal dissection (ESD) now allows en bloc resection of large EGCs.

OBJECTIVE

To retrospectively determine whether ESD is more advantageous than EMR for EGCs.

DESIGN

EMR (825 lesions, 711 patients) or ESD (195 lesions, 185 patients) was performed. The en bloc resection rate, histologically complete resection rate, operation time, complications, and local recurrence rate were studied in relation to ulceration.

SETTING

Hiroshima University Hospital.

PATIENTS

Subjects comprised 896 patients in whom 1020 EGCs were resected endoscopically from 1990 to 2004.

RESULTS

In cases without ulceration, en bloc and histologically complete resection rates were significantly higher with ESD than with EMR, regardless of tumor size. The frequency of ulceration did not differ significantly between groups. Average operation time was significantly longer for ESD than for EMR, regardless of tumor size. Also, regardless of ulceration, the incidence of intraoperative bleeding was significantly higher with ESD (22.6%) than with EMR (7.6%). Delayed bleeding did not differ. In cases with ulceration, the incidence of perforation was significantly higher with ESD (53.8%) than with EMR (2.9%). Local recurrences were treated by incomplete EMR (en bloc, 2.9%; piecemeal, 4.4%). No patient experienced recurrence after ESD.

CONCLUSIONS

ESD increased en bloc and histologically complete resection rates and may reduce the local recurrence rate. Increased operation time and complication risks with ESD in comparison with EMR remain problematic. Special measures are necessary for ESD of ulcerated lesions to reduce the rates of perforation and incomplete resection.

Authors+Show Affiliations

Department of Endoscopy, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17140890

Citation

Oka, Shiro, et al. "Advantage of Endoscopic Submucosal Dissection Compared With EMR for Early Gastric Cancer." Gastrointestinal Endoscopy, vol. 64, no. 6, 2006, pp. 877-83.
Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64(6):877-83.
Oka, S., Tanaka, S., Kaneko, I., Mouri, R., Hirata, M., Kawamura, T., ... Chayama, K. (2006). Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointestinal Endoscopy, 64(6), pp. 877-83.
Oka S, et al. Advantage of Endoscopic Submucosal Dissection Compared With EMR for Early Gastric Cancer. Gastrointest Endosc. 2006;64(6):877-83. PubMed PMID: 17140890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. AU - Oka,Shiro, AU - Tanaka,Shinji, AU - Kaneko,Iwao, AU - Mouri,Ritsuo, AU - Hirata,Mayuko, AU - Kawamura,Toru, AU - Yoshihara,Masaharu, AU - Chayama,Kazuaki, Y1 - 2006/09/20/ PY - 2005/10/18/received PY - 2006/03/31/accepted PY - 2006/12/5/pubmed PY - 2007/2/21/medline PY - 2006/12/5/entrez SP - 877 EP - 83 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 64 IS - 6 N2 - BACKGROUND: In EMR of early gastric cancer (EGC), en bloc resection reduces the risk of residual cancer. Endoscopic submucosal dissection (ESD) now allows en bloc resection of large EGCs. OBJECTIVE: To retrospectively determine whether ESD is more advantageous than EMR for EGCs. DESIGN: EMR (825 lesions, 711 patients) or ESD (195 lesions, 185 patients) was performed. The en bloc resection rate, histologically complete resection rate, operation time, complications, and local recurrence rate were studied in relation to ulceration. SETTING: Hiroshima University Hospital. PATIENTS: Subjects comprised 896 patients in whom 1020 EGCs were resected endoscopically from 1990 to 2004. RESULTS: In cases without ulceration, en bloc and histologically complete resection rates were significantly higher with ESD than with EMR, regardless of tumor size. The frequency of ulceration did not differ significantly between groups. Average operation time was significantly longer for ESD than for EMR, regardless of tumor size. Also, regardless of ulceration, the incidence of intraoperative bleeding was significantly higher with ESD (22.6%) than with EMR (7.6%). Delayed bleeding did not differ. In cases with ulceration, the incidence of perforation was significantly higher with ESD (53.8%) than with EMR (2.9%). Local recurrences were treated by incomplete EMR (en bloc, 2.9%; piecemeal, 4.4%). No patient experienced recurrence after ESD. CONCLUSIONS: ESD increased en bloc and histologically complete resection rates and may reduce the local recurrence rate. Increased operation time and complication risks with ESD in comparison with EMR remain problematic. Special measures are necessary for ESD of ulcerated lesions to reduce the rates of perforation and incomplete resection. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/17140890/Advantage_of_endoscopic_submucosal_dissection_compared_with_EMR_for_early_gastric_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(06)01812-8 DB - PRIME DP - Unbound Medicine ER -