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Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review.

Uedo N, Takeuchi Y, Ishihara R - Ann Gastroenterol (2012)

Bottom Line: Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR.Accordingly, ESD has been established as a standard treatment for management of EGC in Japan.The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist's expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan Endoscopic Learning and Training Center, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

ABSTRACT
As detection of early gastric cancer (EGC) has improved, endoscopic mucosal resection (EMR) has been adopted as a treatment option for small intramucosal carcinoma. Endoscopic submucosal dissection (ESD) has enabled high en bloc resection rate for small and large lesions, as well as those with scarring. Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR. Accordingly, ESD has been established as a standard treatment for management of EGC in Japan. The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist's expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer. Efforts to establish a standardized protocol for practice and training can accelerate dissemination of gastric ESD in regions where gastric cancer is highly prevalent, and may help endoscopists worldwide to adopt this technique for other organs in the digestive tract.

No MeSH data available.


Related in: MedlinePlus

Participant flow of outcome analysis in the Osaka Medical Center for Cancer and Cardiovascular DiseasesEMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection
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Figure 5: Participant flow of outcome analysis in the Osaka Medical Center for Cancer and Cardiovascular DiseasesEMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection

Mentions: Treatment outcomes of EMR and ESD were evaluated with reference to six previous studies [27-32] and our own experience. Moreover, differences in treatment outcomes between EMR and ESD with regard to the different indication categories were investigated in our data. During 1996-2008, 2190 EGCs were treated with endoscopic resection in Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these, 75 lesions in the operated stomach were excluded. Seven lesions could not be retrieved and one lesion was not found to be carcinoma in retrieved specimen, leaving 882 lesions that were treated with EMR and 1233 lesions with ESD for analysis. The resected lesions were retrospectively classified into the following indication-categories according to the endoscopic finding before treatment: the guideline-indication (≤2 cm differentiated adenocarcinoma without ulceration or scaring, for which the depth of invasion was estimated to be intramucosal, n=1388); >2 cm differentiated intramucosal carcinoma without ulceration or scarring (n=378); ≤3 cm differentiated intramucosal carcinoma with ulceration or scarring (n=210); and ≤2 cm undifferentiated intramucosal carcinoma without ulceration or scarring (n=73). Fifty-eight lesions that did not fulfill the indication criteria were treated palliatively because of patients’ comorbidity or old age (Fig. 5).


Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review.

Uedo N, Takeuchi Y, Ishihara R - Ann Gastroenterol (2012)

Participant flow of outcome analysis in the Osaka Medical Center for Cancer and Cardiovascular DiseasesEMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959406&req=5

Figure 5: Participant flow of outcome analysis in the Osaka Medical Center for Cancer and Cardiovascular DiseasesEMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection
Mentions: Treatment outcomes of EMR and ESD were evaluated with reference to six previous studies [27-32] and our own experience. Moreover, differences in treatment outcomes between EMR and ESD with regard to the different indication categories were investigated in our data. During 1996-2008, 2190 EGCs were treated with endoscopic resection in Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these, 75 lesions in the operated stomach were excluded. Seven lesions could not be retrieved and one lesion was not found to be carcinoma in retrieved specimen, leaving 882 lesions that were treated with EMR and 1233 lesions with ESD for analysis. The resected lesions were retrospectively classified into the following indication-categories according to the endoscopic finding before treatment: the guideline-indication (≤2 cm differentiated adenocarcinoma without ulceration or scaring, for which the depth of invasion was estimated to be intramucosal, n=1388); >2 cm differentiated intramucosal carcinoma without ulceration or scarring (n=378); ≤3 cm differentiated intramucosal carcinoma with ulceration or scarring (n=210); and ≤2 cm undifferentiated intramucosal carcinoma without ulceration or scarring (n=73). Fifty-eight lesions that did not fulfill the indication criteria were treated palliatively because of patients’ comorbidity or old age (Fig. 5).

Bottom Line: Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR.Accordingly, ESD has been established as a standard treatment for management of EGC in Japan.The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist's expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan Endoscopic Learning and Training Center, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

ABSTRACT
As detection of early gastric cancer (EGC) has improved, endoscopic mucosal resection (EMR) has been adopted as a treatment option for small intramucosal carcinoma. Endoscopic submucosal dissection (ESD) has enabled high en bloc resection rate for small and large lesions, as well as those with scarring. Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR. Accordingly, ESD has been established as a standard treatment for management of EGC in Japan. The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist's expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer. Efforts to establish a standardized protocol for practice and training can accelerate dissemination of gastric ESD in regions where gastric cancer is highly prevalent, and may help endoscopists worldwide to adopt this technique for other organs in the digestive tract.

No MeSH data available.


Related in: MedlinePlus