• Journal of Gastric Cancer
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• 제10권2호
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• pp.49-54
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• 2010

Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than $500\;{\mu}m$). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1803-1806
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• 2014

Endoscopic submucosal dissection (ESD) was originally developed for en bloc resection of large, flat gastrointestinal lesions. Compared with endoscopic mucosal resection (EMR), ESD is considered to be more time consuming and have more complications for treatment of early esophageal carcinoma, such as bleeding, stenosis and perforation. The objective of this study was to compare the efficacy and safety of ESD and EMR for such lesions. We searched databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 for related trials. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histologically resection rate and the local recurrence rate. We also compared the operation time and the incidences of procedure-related complications. Five trials were identified, and a total of 710 patients and 795 lesions were included. The en bloc and histologically complete resection rates were higher in the ESD group compared with the EMR group (odds ratio (OR) 27.3; 95% CI, 11.5-64.8; OR 18.4; 95% CI, 8.82-38.59). The local recurrence rate was lower in the ESD group (OR 0.13, 95 % CI 0.04-0.43). The meta-analysis also showed ESD was more time consuming, but did not increase the complication rate (P=0.76). The results implied that compared with EMR, ESD showed better en bloc and histologically resection rates, and lower local recurrence, without increasing the incidence of procedure-related complications in the treatment of early esophageal carcinoma.

• Journal of Gastric Cancer
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• 제24권2호
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• pp.199-209
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• 2024

Purpose: Long-term outcomes of patients with positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to evaluate the remnant cancer and survival rates of patients with pLMs compared with those who underwent curative resection. Materials and Methods: A retrospective analysis was performed on consecutive patients with pLMs as the only non-curative factor of expanded indication who underwent ESD for EGC with a follow-up duration of 5 years or more. The rates of remnant cancer, recurrence, and survival were analyzed and compared to those of control patients who underwent curative resection by propensity score matching. Results: Among 3,515 patients treated with ESD between 2005 and 2018, 123 non-curative EGCs were retrospectively analyzed. A total of 108 patients were followed up without endoscopic or surgical resection for 8.2 years. The control group was matched in a 1:1 ratio with patients with EGC who underwent curative resection after ESD. The observation group with pLMs had a higher incidence of remnant cancer (25.9%; 28/108) compared to that in the curative resection group (0/108; P=0.000). The remaining tumors were treated with surgical or endoscopic resection, and no additional recurrences were observed. The overall survival analysis demonstrated no significant difference between the observation and curative resection groups (P=0.577). Conclusions: No difference was observed in the overall survival rate between observation and curative resection groups. Therefore, observation may be a possible option for incomplete ESD with pLMs if continuous follow-up is performed.

• Clinical Endoscopy
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• 제56권5호
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• pp.613-622
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases. Methods: This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality. Results: Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months. Conclusions: ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.

• Journal of Gastric Cancer
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• 제18권4호
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• pp.400-408
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• 2018

Purpose: This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection. Materials and Methods: We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017. Results: Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed. Conclusions: In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

• Journal of Gastric Cancer
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• 제10권3호
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• pp.87-90
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• 2010

Early gastric cancer (EGC) is defined as tumor invasion confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis. Lymph node metastasis is the most powerful and important prognostic factor for gastric cancer. Based on the risk of lymph node metastasis in EGC obtained from a large number of surgical cases in Japan, it was suggested that the criteria for endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD) as local treatment for EGC might be extended. However, extending the indications for EMR and ESD remains controversial because the long-term outcomes of these procedures have not been fully documented, and there is a risk for lymph node metastasis. Furthermore, current diagnostic imaging techniques are unsatisfactory for accurately predicting metastasis to lymph nodes. Moreover, the long-term results of standard radical gastrectomy including minimally invasive procedures for stage IA have been increasing and have reached 99 to 100%. To determine the true efficacy of endoscopic resection of EGC, we need more evidence of long-term follow-up, standardization of techniques, and pathological interpretation.

• 대한소화기학회지
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• 제72권5호
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• pp.258-261
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• 2018

Esophageal basaloid squamous carcinoma (BSC) is a rare, aggressive variant of squamous cell carcinoma. BSC is usually diagnosed in advanced stage and its prognosis is relatively poor. A 59-year-old male with subepithelial lesion of the esophagus that was incidentally discovered during health promotion examination was referred to our hospital. Esophagogastroduodenoscopy showed a 10-mm bulging mucosa with an intact surface at 34 cm from incisor teeth. Endoscopic ultrasonography revealed a smooth margined homogenous hypoechoic lesion, measuring $11.3{\times}3.9mm$ with a submucosal layer of origin. The patient underwent endoscopic mucosal resection of the subepithelial lesion. Pathologic examination of the resected specimen revealed BSC with involvement of vertical margin by tumor. The patient then underwent radiotherapy, and is doing well without recurrence for 35 months. We report a case of esophageal BSC confined to submucosal layer successfully treated with endoscopic resection followed by radiation.

• Clinical Endoscopy
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• 제56권1호
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• pp.55-64
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

• Clinical Endoscopy
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• 제56권4호
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• pp.423-432
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• 2023

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.44-49
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• 2017

Background: 최근 제안된 조기위암에 대한 미세침습 치료법은 내시경점막하박리술(endoscopic submucosal dissection, ESD)혹은 종양 부위를 전층 절제(endoscopic full-thickness gastric resection, EFTGR)을 통해 위 절제를 최소화하고 동시에 복강경을 통해 감시림프절 절제(sentinel lymph node dissection, SLND)를 시행함으로써 그 가능성을 제시했었고, 이들을 각각 ESN (endoscopic submucosal dissection with laparoscopic sentinel lymph node dissection), Hybrid-NOTES (endoscopic full-thickness gastric resection with laparoscopic sentinel lymph node dissection)라고 명명하였다. 본 고에서는 림프절 전이 위험성이 높은 조기위암에 대해 이 두 치료법을 시행받은 환자들의 장기 추적 결과를 평가하고자 한다. Methods: 이 후향적 연구는 2009년 1월부터 2013년 5월 중에 ESN 혹은 Hybrid-NOTES를 시행받은 환자들이 포함되었다. Results: 총 42명의 환자들이 연구에 포함되었고, ESN 21명, Hybrid-NOTES 21명이 각각 등록되었다. ESN을 시행받은 21명 중 4명, Hybrid-NOTES를 시행받은 5명은 이 미세침습수술 후 추가 수술을 받아야 했다. 아직까지 이 수술 후 사망 환자는 없지만 ESN을 시행받은 1명의 환자에서 림프절 전이가 발견되어 항암치료를 받고 있다. Conclusion: 조기위암의 미세침습 수술인 ESN 혹은 Hybrid-NOTES는 좋은 장기 추적 결과를 보여주었다. 이 방법들은 향후 림프절 전이 위험성이 높은 조기위암에서 ESD와 gastrectomy 사이에 속한 환자들에게 좋은 치료법이 될 수 있을 거라고 생각된다.