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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

Delayed bleeding rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
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Figure 8: Delayed bleeding rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution

Mentions: Delayed bleeding and perforation are the major complications of endoscopic resection for EGC. Delayed bleeding occurs in 2.5-3.9% of EMR patients and 1.8-16% of ESD patients (Table 4). ESD has a higher rate of delayed bleeding than EMR and delayed bleeding is more frequent for expanded indication lesions compared to guideline-indication lesions (Fig. 8). Routine coagulation of all visible vessels at the post-ESD mucosal defect decreases the rate of delayed hemorrhage [33] and is performed as standard practice. Administration of proton pump inhibitors reduces incidence of delayed bleeding compared to administration of histamine 2-receptor antagonists [34].


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)

Delayed bleeding 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 8: Delayed bleeding rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
Mentions: Delayed bleeding and perforation are the major complications of endoscopic resection for EGC. Delayed bleeding occurs in 2.5-3.9% of EMR patients and 1.8-16% of ESD patients (Table 4). ESD has a higher rate of delayed bleeding than EMR and delayed bleeding is more frequent for expanded indication lesions compared to guideline-indication lesions (Fig. 8). Routine coagulation of all visible vessels at the post-ESD mucosal defect decreases the rate of delayed hemorrhage [33] and is performed as standard practice. Administration of proton pump inhibitors reduces incidence of delayed bleeding compared to administration of histamine 2-receptor antagonists [34].

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