Endoscopy 2010; 42(12): 1037-1044
DOI: 10.1055/s-0030-1255668
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection in gastric neoplasia – experience from a European center

A.  Probst1 , B.  Pommer1 , D.  Golger1 , M.  Anthuber2 , H.  Arnholdt3 , H.  Messmann1
  • 1III Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
  • 2Department of Surgery, Klinikum Augsburg, Augsburg, Germany
  • 3Institute of Pathology, Klinikum Augsburg, Augsburg, Germany
Further Information

Publication History

submitted 10 February 2010

accepted after revision 16 June 2010

Publication Date:
22 October 2010 (online)

Background and study aims: Endoscopic submucosal dissection (ESD) is a promising technique for the resection of early gastric neoplasia. There are only a few data from the Western world to date.

Methods: Over a 7-year-period, 104 gastric lesions were treated with ESD in a European referral center, of which 91 were included in this study. A total of 66 lesions were early gastric cancer (EGC) and 25 were adenomas. Of the EGCs, 11 lesions (16.7 %) fulfilled the guideline criteria (EGC-GC) and 55 lesions (83.3 %) fulfilled the expanded resection criteria (EGC-EC) of the Japanese guidelines for the treatment of gastric cancer.

Results: ESD was technically possible in 85 lesions (93.4 %). In six lesions ESD was not possible due to non-lifting. En bloc resection rates for all lesions, ECGs-GC, ECGs-EC, and adenomas were 87.1 %, 100 %, 88.2 %, and 79.2 %, respectively. R0 en bloc resection rates were 74.1 %, 90 %, 68.6 %, and 79.2 %, respectively. Complications were: one perforation during piecemeal endoscopic mucosal resection of a lesion in which ESD was judged to be impossible (1.2 %); three clinically relevant bleedings (3.5 %); one gastric ischemia (1.2 %); and four strictures (4.7 %). No mortality was observed. There were five recurrences after piecemeal resection (50 %) compared with only one after en bloc resection (1.5 %; P < 0.05). The rate of recurrence for EGCs was 5.6 %, and this were seen exclusively after piecemeal resection.

Conclusions: Our data show that ESD is a feasible technique in Europe even in patients with EGC according to the extended criteria. Resection rates are promising and complication rates are acceptable. Results are worse compared with large studies from Japan but still excellent regarding the learning curve of the method. ESD should be offered as the treatment of choice for early gastric neoplasia especially when en bloc resection cannot be performed with other resection techniques.

References

  • 1 Rembacken B J, Gotoda T, Fujii T, Axon A T. Endoscopic mucosal resection.  Endoscopy. 2001;  33 709-718
  • 2 Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract.  J Clin Oncol. 2005;  23 4490-4498
  • 3 Miyamoto S, Muto M, Hamamoto Y. et al . A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms.  Gastrointest Endosc. 2002;  55 576-581
  • 4 Yamamoto H, Kawata H, Sunada K. et al . Successful en-bloc-resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small caliber-tip-transparent hood.  Endoscopy. 2003;  35 690-694
  • 5 Japanese Gastric Cancer Association . Japanese classification of gastric carcinoma – second English edition.  Gastric Cancer. 1998;  1 10-24
  • 6 Gotoda T, Yanagisawa A, Sasako M. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric cancer. 2000;  3 219-225
  • 7 Isomoto H, Shikuwa S, Yamaguchi N. et al . Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study.  Gut. 2009;  58 331-336
  • 8 Park J M, Kim S W, Nam K W. et al . Is it reasonable to treat early gastric cancer with signet ring cell histology by endoscopic resection? Analysis of factors related to lymph node metastasis.  Eur J Gastroenterol Hepatol. 2009;  21 1132-1135
  • 9 Probst A, Golger D, Arnholdt H, Messmann H. Endoscopic submucosal dissection of early cancers, flat adenomas and submucosal tumors in the gastrointestinal tract.  Clin Gastroenterol Hepatol. 2009;  7 149-155
  • 10 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M. et al . A European case series of endoscopic submucosal dissection for gastric superficial lesions.  Gastrointest Endosc. 2009;  69 350-355
  • 11 Hosokawa K, Yoshida S. Recent advances in endoscopic mucosal resection for early gastric cancer.  Gan To Kagaku Ryoho. 1998;  25 476-483
  • 12 Onozato Y, Ishihara H, Iizuka H. et al . Endoscopic submucosal dissection for early gastric cancers and large flat adenomas.  Endoscopy. 2006;  38 980-986
  • 13 Forman D, Burley V J. Gastric cancer: global pattern of the disease and an overview of environmental risk factors.  Best Pract Res Clin Gastroenterol. 2006;  20 633-649
  • 14 Choi I J, Kim C G, Chang H J. et al . The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm.  Gastrointest Endosc. 2005;  62 860-865
  • 15 Yamaguchi N, Isomoto H, Fukuda E. et al . Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria.  Digestion. 2009;  80 173-181
  • 16 Hitomi G, Watanabe H, Tominaga K. et al . Endoscopic submucosal dissection in 100 lesions with early gastric carcinoma.  Hepatogastroenterology. 2009;  56 254-260

H. MessmannMD 

III Medizinische Klinik
Klinikum Augsburg

Stenglinstraße 2
86156 Augsburg
Germany

Fax: +49-821-4003331

Email: helmut.messmann@klinikum-augsburg.de

    >