The Usefulness and Limitation of Endoscopic Mucosal Resection Using the Incision and Submucosa Dissection (EISD) Methods for Early Gastric Cancer and Gastric Flat Adenoma in Korea

Abstract

Background: Conventional EMR technique is technically simple and convenient but with this procedure the size of specimen obtained from en bloc resection is very limited. En bloc resection is beneficial for accurate histopathological assessment of resected specimen of endoscopic mucosal resection (EMR). EMR using Incision and dissection methods (EISD) made it possible to perform en bloc resections of larger early stage gastric neoplasm with a reduction in the recurrence rate. But, it takes long time to perform the procedure and high incidence of complication. Aims: The aim of this study was to evaluate the clinical usefullness and limitation of EISD. Subjects & Methods: Between February 2001 and April 2004 September, 271 lesions of early neoplastic lesions of the stomach (M:F = 169:70, mean age: 60.99) were performed by EMR with conventional method (EMR, n = 41) or EISD (n = 230). En bloc and complete resection rates, the total procedure time, recurrence and complication were evaluated. Results: 1) The en bloc resection and complete resection rates with EMR were 93.3% (14/15), 86.6% (13/15) for lesions 10 mm or less in size and 88.5% (23/26), 61.5% (16/26) between 11 and 15 mm. EISD, 91.2% (52/57), 89.5% (51/57) between 11 and 15 mm, 96.4% (54/56), 83.9% (47/56) 16-20 mm, 87.1% (54/62), 91.9% (57/62) 21-30 mm, 89% (49/55), 81.9% (45/55) for lesions 31 mm or more in size. 2) The total procedure time of EMR and EISD was 19¡¯ 58¡± ¡¾ 5¡¯ 52¡± and 103¡¯ 30¡± ¡¾ 45¡¯ 46¡± 3)Recurrence rate was 9.6% (4/41) in EMR, 3.5% (8/230) in EISD. 4) Minor bleeding including oozing with conventional EMR occurred in 2.4% (1/41) and EISD 5.7% (13/230). Perforation with EISD only occurred in 3.0% (7/230). Conclusion: EISD was effective modality to perform high en bloc resection and complete resection rate in larger gastric flat adenoma and early gastric cancer. To avoid the complications such as perforation, it takes a lots of technical experiences. Key word: Gastric Neoplasms, endoscopic mucosal resection, Incision and dissection method, Endoscopic mucosal resection. Background: Conventional EMR technique is technically simple and convenient but with this procedure the size of specimen obtained from en bloc resection is very limited. En bloc resection is beneficial for accurate histopathological assessment of resected specimen of endoscopic mucosal resection (EMR). EMR using Incision and dissection methods (EISD) made it possible to perform en bloc resections of larger early stage gastric neoplasm with a reduction in the recurrence rate. But, it takes long time to perform the procedure and high incidence of complication. Aims: The aim of this study was to evaluate the clinical usefullness and limitation of EISD. Subjects & Methods: Between February 2001 and April 2004 September, 271 lesions of early neoplastic lesions of the stomach (M:F = 169:70, mean age: 60.99) were performed by EMR with conventional method (EMR, n = 41) or EISD (n = 230). En bloc and complete resection rates, the total procedure time, recurrence and complication were evaluated. Results: 1) The en bloc resection and complete resection rates with EMR were 93.3% (14/15), 86.6% (13/15) for lesions 10 mm or less in size and 88.5% (23/26), 61.5% (16/26) between 11 and 15 mm. EISD, 91.2% (52/57), 89.5% (51/57) between 11 and 15 mm, 96.4% (54/56), 83.9% (47/56) 16-20 mm, 87.1% (54/62), 91.9% (57/62) 21-30 mm, 89% (49/55), 81.9% (45/55) for lesions 31 mm or more in size. 2) The total procedure time of EMR and EISD was 19¡¯ 58¡± ¡¾ 5¡¯ 52¡± and 103¡¯ 30¡± ¡¾ 45¡¯ 46¡± 3)Recurrence rate was 9.6% (4/41) in EMR, 3.5% (8/230) in EISD. 4) Minor bleeding including oozing with conventional EMR occurred in 2.4% (1/41) and EISD 5.7% (13/230). Perforation with EISD only occurred in 3.0% (7/230). Conclusion: EISD was effective modality to perform high en bloc resection and complete resection rate in larger gastric flat adenoma and early gastric cancer. To avoid the complications such as perforation, it takes a lots of technical experiences. Key word: Gastric Neoplasms, endoscopic mucosal resection, Incision and dissection method, Endoscopic mucosal resection.