Endoscopic Submucosal Dissection May Become a Standard Treatment for Intramucosal Gastric Tumors with Differentiated Type

Abstract

Background: Endoscopic resection has been accepted as the standard treatments for intramucosal gastric tumors with differentiated type. These days, we have developed endoscopic submucosal dissection (ESD) as a new endoscopic resection technique. In this study, we investigated the feasibility of ESD in comparison with conventional endoscopic mucosal resection (EMR) such as strip biopsy and cap-technique. Methods: We retrospectively analyzed the data of 360 intramucosal gastric tumors with differentiated type in final histology with endoscopic resection at the University Hospital from July 1991 to September 2004. From the data, we investigated an en bloc resection rate, a complete resection rate, and a cumulative local recurrent rate. Complete resection was defined as tumor-free resected margins in lateral and vertical directions even if the lesion was resected with multiple fragments. Statistical analysis was performed by chi-square analysis. Results: Among 360 lesions, 100 and 260 lesions were resected with conventional EMR and ESD, respectively. En bloc resection rates were 55% (55/100) and 92.7% (241/260) in the conventional EMR group and the ESD group, respectively (p < 0.05). Complete resection rates were 68% (68/100) and 91.9% (239/260) in the conventional EMR group and the ESD group, respectively (p < 0.05). Furthermore, 13 lesions recurred locally, not in metastatic area, in the conventional EMR group and, on the contrary, none recurred in the ESD group. Conclusions: ESD results in far excellent en bloc and complete resection rates in comparison with conventional EMR. Background: Endoscopic resection has been accepted as the standard treatments for intramucosal gastric tumors with differentiated type. These days, we have developed endoscopic submucosal dissection (ESD) as a new endoscopic resection technique. In this study, we investigated the feasibility of ESD in comparison with conventional endoscopic mucosal resection (EMR) such as strip biopsy and cap-technique. Methods: We retrospectively analyzed the data of 360 intramucosal gastric tumors with differentiated type in final histology with endoscopic resection at the University Hospital from July 1991 to September 2004. From the data, we investigated an en bloc resection rate, a complete resection rate, and a cumulative local recurrent rate. Complete resection was defined as tumor-free resected margins in lateral and vertical directions even if the lesion was resected with multiple fragments. Statistical analysis was performed by chi-square analysis. Results: Among 360 lesions, 100 and 260 lesions were resected with conventional EMR and ESD, respectively. En bloc resection rates were 55% (55/100) and 92.7% (241/260) in the conventional EMR group and the ESD group, respectively (p < 0.05). Complete resection rates were 68% (68/100) and 91.9% (239/260) in the conventional EMR group and the ESD group, respectively (p < 0.05). Furthermore, 13 lesions recurred locally, not in metastatic area, in the conventional EMR group and, on the contrary, none recurred in the ESD group. Conclusions: ESD results in far excellent en bloc and complete resection rates in comparison with conventional EMR.