| Theme | Laparoscopic and Endoscopic Therapy for Digestive Organ | |
|---|---|---|
| Title | Recent Advances in Endoscopic Mucosal Resection for Early Gastric Cancer | |
| Publish Date | 1999/02 | |
| Author | Koichi Hosokawa | Division of Endoscopy, National Cancer Center Hospital East |
| Author | Hisao Tajiri | Division of Endoscopy, National Cancer Center Hospital East |
| [ Summary ] | Our indications for Endoscopic Mucosal Resection (EMR) for early gastric cancer (EGC) as a radical treatment are as follows, (1) Histology:Intestinal type, (2) Macroscopic type :IIa and IIc, (3) Without ulcerative change. We do not put restrictions on the size of the lesion. Lesions which are suspected to have submucosal invasion are recieve EMR for diagnostic purposes. The ratio of EMR cases in relation to total EGC cases has increased in recent years and amounted to about 40% of EGCs treated at the National Cancer Center Hospital in 1996. From 1987 to 1996,we had 440 cases of EGCs (intestinal type, histologically) at National Cancer Center Hospital and National Cancer Center Hospital East. Eighty five cases (19.3%) turned out to have submucosal invasion. The overall rate of cut-end-free cases was 72.7%. And the overall rate of curative resection (excluding cases with submucosal invasion) was 63.0%. Though we had 37 reccurent cases after EMR, we have had no fatalities resulting from the original disease with additional treatment or observation (due to complications or age). To resect larger lesions in one piece, we have begun EMR with cutting the mucosa around the lesion using a newly improved endoscopic devise named an insulation-tipped diathermic knife (IT knife) from 1995. With the IT knifeļ¼ we could resect 75% of lesions from 11 to 20mm in size in one piece, while we could resect 29% with the conventional method (strip biopsy). Though the results of EMR have improved in recent years, new endoscopic techniques for easy and dependable EMR are expected to be developed soon. |
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