Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection
Submitted 19 May 2006
Accepted after revision 3 July 2006
20 October 2006 (online)
Background and study aims: Endoscopic mucosal resection (EMR) is a widely accepted treatment for early gastric cancer; however, incomplete resection with residual local disease and recurrences continues to be a difficult problem. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for residual/local recurrent early gastric cancer lesions after EMR.
Patients and methods: The en bloc resection rate, histologically complete resection rate, complications, and local recurrence were assessed in 15 patients who underwent ESD for residual/local recurrent early gastric cancer lesions after EMR.
Results: The nonlifting sign after injection of a glycerin solution was positive due to scar formation in all cases. En bloc resection was attempted in all cases, with a complete resection rate of 93.3 % (14 of 15). The lesion was completely resected with histologically adequate margins in the 14 patients who received complete en bloc resection. The average operation time was 85.4 ± 52.9 min, and the mean follow-up period for all patients was 18.1 ± 7.4 months. Major bleeding during the procedure in one case was the only complication (one of 15, 6.7 %). None of the patients experienced recurrence of early gastric cancer after ESD.
Conclusions: ESD appears to be a safe and effective treatment for residual/local recurrent early gastric cancer lesions after EMR, and it is useful for histological confirmation of successful treatment.
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S. Tanaka, M. D., Ph. D.
Dept. of Endoscopy
Hiroshima University Hospital · 1-2-3 Kasumi, Minami-ku · Hiroshima 734-8551 · Japan