Strategy of Endoscopic Treatment for Early Gastric Cancer in a Primary Hospital

Abstract

Background: Endoscopic mucosal resection (EMR) is an accepted treatment for early gastric cancer (EGC) associated with a minimal risk of regional lymph node metastasis, and it has been increasingly gaining acceptance in the western countries. Recently, endoscopic submucosal dissection (ESD) has been the treatment of choice in many cases, because it improves the completeness of en-bloc resection of superficial early gastric cancer. We aimed to compare standard EMR with ESD for early gastric cancer treatment to evaluate resected specimens and respectability. Patients and Methods: 82 early gastric cancers (65 men, 17 women, age range 52-86 years) were treated by EMR of the lift and cut technique using double channel scope (GIF-2T240, Olympus, Tokyo, Japan) between Dec 2003 and Nov 2006. 92 early gastric cancers (68 men, 24 women, age range 49-89 years) were treated by ESD using single channel scope (GIF-Q240, Olympus, Tokyo, Japan) and KD-630L (Flex Knife TM, Olympus, Tokyo, Japan). We evaluated the rate of en-bloc resection and the size of the tumors and resected specimens. In the cases of the resection in multiple fragments, resectability was evaluated based on completely reconstructed specimens and the size of the tumor was measured on those specimens. And the largest specimen of multiple fragments was regarded as the size of resected specimens. Informed written consent for EMR and ESD was obtained from all patients. Results: The mean sizes of the resected tumors using EMR and ESD techniques were 8.7 mm (range, 2.0-23 mm) and 13 mm (range, 2.0-50 mm) (P < 0.05), and the mean size of the resected specimens were 18 mm (range, 9-31 mm) and 31 mm (range, 13-80 mm) (P < 0.05), respectively. The rates of en-bloc resection and complete resection of EMR were 66% (54/82) and 76% (62/82), and those of ESD were 93% (86/92) (P < 0.05) and 96% (88/92) (P < 0.05), respectively. Regarding to the size, the confirmation of en-bloc resections could only be confirmed in 58% (37/64) of lesions larger than 5 mm, using standard EMR technique. But in the lesions less than 5 mm, 94% (17/18) was resected en-bloc. Conclusion: Our results demonstrate that Gastric ESD is an effective method for EGC en-bloc resections regardless of the lesion size, but the resection can be performed by standard EMR in smaller lesions (<5 mm).