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Endoscopic submucosal dissection is an effective and safe therapy for early gastric neoplasms: a multicenter feasible study.
J Clin Gastroenterol 2012; 46(2):124-9JC

Abstract

BACKGROUND AND AIM

The technique of endoscopic submucosal dissection (ESD) was introduced to obtain en bloc specimens of large early gastrointestinal neoplasms. The drawback of ESD is its technical difficulty and, consequently, its higher rate of complication. In this multicenter study, we investigated the therapeutic outcomes of ESD in consecutive patients.

METHODS

From January 2002 to December 2008, 485 early gastric neoplasms in 418 patients were consecutively treated by using ESD procedure performed by 6 endoscopists in 4 institutions in Tokyo. Demorgraphics, tumor location, therapeutic outcomes, and complication rates were analyzed.

RESULTS

The rates of en bloc resection, complete en bloc resection, submucosal invasion, and piecemeal resection were 93.6%, 85.4%, 10.9%, and 5.4%, respectively. In multivariate analysis, the en bloc resection rate was independently lower in lesions in upper portion than in lower portion (P<0.01), lower in larger lesions (>30 mm, P<0.05; 20 to 30 mm, P<0.05), and lower in lesions with a scar (P<0.01). Delayed bleeding occurrence was independently high in larger lesions (>30 mm, P<0.01; 20 to 29 mm, P<0.01) than in small lesions (<20 mm). Institution and endoscopists were not risk factors of en bloc resection and complications

CONCLUSIONS

ESD is an effective and safe therapy in the management of early gastric neoplasms when performed by well-trained endoscopists. Endoscopists should recognize the difficulty to perform ESD for en bloc resection of upper lesion, and the risk of delayed bleeding in cases of lesions >2 cm in size.

Authors+Show Affiliations

Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. sugimot-tky@umin.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Multicenter Study

Language

eng

PubMed ID

21959325

Citation

Sugimoto, Takafumi, et al. "Endoscopic Submucosal Dissection Is an Effective and Safe Therapy for Early Gastric Neoplasms: a Multicenter Feasible Study." Journal of Clinical Gastroenterology, vol. 46, no. 2, 2012, pp. 124-9.
Sugimoto T, Okamoto M, Mitsuno Y, et al. Endoscopic submucosal dissection is an effective and safe therapy for early gastric neoplasms: a multicenter feasible study. J Clin Gastroenterol. 2012;46(2):124-9.
Sugimoto, T., Okamoto, M., Mitsuno, Y., Kondo, S., Ogura, K., Ohmae, T., ... Koike, K. (2012). Endoscopic submucosal dissection is an effective and safe therapy for early gastric neoplasms: a multicenter feasible study. Journal of Clinical Gastroenterology, 46(2), pp. 124-9. doi:10.1097/MCG.0b013e31822f3988.
Sugimoto T, et al. Endoscopic Submucosal Dissection Is an Effective and Safe Therapy for Early Gastric Neoplasms: a Multicenter Feasible Study. J Clin Gastroenterol. 2012;46(2):124-9. PubMed PMID: 21959325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic submucosal dissection is an effective and safe therapy for early gastric neoplasms: a multicenter feasible study. AU - Sugimoto,Takafumi, AU - Okamoto,Makoto, AU - Mitsuno,Yuzo, AU - Kondo,Shintaro, AU - Ogura,Keiji, AU - Ohmae,Tomoya, AU - Mizuno,Hideo, AU - Yoshida,Shuntaro, AU - Isomura,Yoshihiro, AU - Yamaji,Yutaka, AU - Kawabe,Takao, AU - Omata,Masao, AU - Koike,Kazuhiko, PY - 2011/10/1/entrez PY - 2011/10/1/pubmed PY - 2012/5/18/medline SP - 124 EP - 9 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 46 IS - 2 N2 - BACKGROUND AND AIM: The technique of endoscopic submucosal dissection (ESD) was introduced to obtain en bloc specimens of large early gastrointestinal neoplasms. The drawback of ESD is its technical difficulty and, consequently, its higher rate of complication. In this multicenter study, we investigated the therapeutic outcomes of ESD in consecutive patients. METHODS: From January 2002 to December 2008, 485 early gastric neoplasms in 418 patients were consecutively treated by using ESD procedure performed by 6 endoscopists in 4 institutions in Tokyo. Demorgraphics, tumor location, therapeutic outcomes, and complication rates were analyzed. RESULTS: The rates of en bloc resection, complete en bloc resection, submucosal invasion, and piecemeal resection were 93.6%, 85.4%, 10.9%, and 5.4%, respectively. In multivariate analysis, the en bloc resection rate was independently lower in lesions in upper portion than in lower portion (P<0.01), lower in larger lesions (>30 mm, P<0.05; 20 to 30 mm, P<0.05), and lower in lesions with a scar (P<0.01). Delayed bleeding occurrence was independently high in larger lesions (>30 mm, P<0.01; 20 to 29 mm, P<0.01) than in small lesions (<20 mm). Institution and endoscopists were not risk factors of en bloc resection and complications CONCLUSIONS: ESD is an effective and safe therapy in the management of early gastric neoplasms when performed by well-trained endoscopists. Endoscopists should recognize the difficulty to perform ESD for en bloc resection of upper lesion, and the risk of delayed bleeding in cases of lesions >2 cm in size. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/21959325/Endoscopic_submucosal_dissection_is_an_effective_and_safe_therapy_for_early_gastric_neoplasms:_a_multicenter_feasible_study_ L2 - http://dx.doi.org/10.1097/MCG.0b013e31822f3988 DB - PRIME DP - Unbound Medicine ER -