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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

En bloc resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
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Figure 6: En bloc resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution

Mentions: Outcomes of each method in the literature review and our center are summarized in Table 5. The rate of en bloc resection that was defined as one-piece resection without tumor invasion to the resected margin was 50-70% for EMR, whereas it was almost 90-95% for ESD. The difference in en bloc resection rate was also higher for ESD than EMR in our experience, and the difference in en bloc resection rate between EMR and ESD was more evident for expanded indication lesions (EMR: 20-40% vs. ESD: 75-85%) than for guideline-indication lesions (EMR: 64% vs. ESD: 95%, Fig. 6). When histological findings of the resected specimens fulfilled the curable criteria listed in Table 4, the resection was regarded as curative. Curative resection rates of EMR and ESD were 55-60% and 75-95%, respectively (Table 5). The discrepancy between en bloc and curative resection rates for ESD lesions was mainly caused by lesions that had submucosal invasion and/or lymphatic involvement. Non-curative resection rate for ESD for guideline-indication lesions was only 10%, whereas that for lesions >2 cm, lesions with scarring and undifferentiated lesions was 33%, 39% and 68%, respectively, and subsequent surgery was recommended (Fig. 7). Prior to the procedure, all patients should be informed for the possibility of additional surgery following ESD. This risk is higher for those fulfilling the expanded indications for endoscopic resection.


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)

En bloc resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: En bloc resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
Mentions: Outcomes of each method in the literature review and our center are summarized in Table 5. The rate of en bloc resection that was defined as one-piece resection without tumor invasion to the resected margin was 50-70% for EMR, whereas it was almost 90-95% for ESD. The difference in en bloc resection rate was also higher for ESD than EMR in our experience, and the difference in en bloc resection rate between EMR and ESD was more evident for expanded indication lesions (EMR: 20-40% vs. ESD: 75-85%) than for guideline-indication lesions (EMR: 64% vs. ESD: 95%, Fig. 6). When histological findings of the resected specimens fulfilled the curable criteria listed in Table 4, the resection was regarded as curative. Curative resection rates of EMR and ESD were 55-60% and 75-95%, respectively (Table 5). The discrepancy between en bloc and curative resection rates for ESD lesions was mainly caused by lesions that had submucosal invasion and/or lymphatic involvement. Non-curative resection rate for ESD for guideline-indication lesions was only 10%, whereas that for lesions >2 cm, lesions with scarring and undifferentiated lesions was 33%, 39% and 68%, respectively, and subsequent surgery was recommended (Fig. 7). Prior to the procedure, all patients should be informed for the possibility of additional surgery following ESD. This risk is higher for those fulfilling the expanded indications for endoscopic resection.

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