Endoscopic Submucosal Dissection for Early Gastric Cancer and Gastric Adenoma: 3-Years Experience in a Single Center

Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) enables en-bloc complete resection of various gastrointestinal tumors compared with conventional endoscopic mucosal resection (EMR), and has been promising treatment option of early gastric cancer (EGC). This study aimed to evaluate clinical outcome of ESD for EGC and gastric adenoma using insulation-tipped diathermic knife. Methods: From April 2005 to June 2008, 884 patients (452 EGC and 432 gastric adenomas) were enrolled prospectively after ESD in Seoul National University Hospital. Follow-up endoscopies were performed in 3, 6, 12, 18 months, and then annually. Complete resection rate, complications, concordance of diagnosis in between the pre-treatment forcep-biopsy and pathologic mapping of ESD specimen and synchronous or metachronous lesions during follow-up were evaluated. Results: The median follow-up duration was 13.4 ± 9.7 months (range 3-39 months). The en bloc resection rate was 100%, complete resection rate was 91.1%(801/884) on the pathologic mapping and 96.4% (703/729) in 3-month follow-up endoscopy. Perforation occurred in 1.1% (10/884) and bleeding was noticed in 3.6% (32/884). There was no complication requiring operation or procedure related mortality. Gastric adenoma in the pre-treatment biopsy were finally proven as EGC with pathologic mapping in 22.5% (119/529) of cases. During the follow-up, 2% (9/432) of adenoma cases were retreated for the remnant lesion with argon-plasma coagulation (APC) or additional ESD. Additional surgical resection was performed in 5.1% (23/452) of EGC patients due to a residual lesion, tumor invasion more than deep submucosal layer, lymphatic invasion or undifferentiated carcinoma. Among the 23 surgically resected cases, there was residual carcinoma in 17.4%(4/23) and lymph node metastasis in 21.7% (5/23). One case revealed synchronous lesion at a different location from the initial ESD site (4.3%, 1/23). During follow-up period, 160 synchronous lesions (18.1%) within 1 year and 20 metachronous lesions (2.3%) were reported. No distant or lymph node metastasis was found during the follow-up. Conclusions: ESD shows high complete resection rate and more accurate pathologic diagnosis of EGC and gastric adenoma, and close follow-up is warranted for detection of synchronous or metachronous lesion.