| Theme | Future Perspectives of Therapeutic Endoscopy Such as ESD and NOTES | |
|---|---|---|
| Title | Gastric ESD : Current Status and Unresolved Issues | |
| Publish Date | 2011/03 | |
| Author | Ichiro Oda | Endoscopy Division, National Cancer Center Hospital |
| Author | Haruhisa Suzuki | Endoscopy Division, National Cancer Center Hospital |
| Author | Shigetaka Yoshinaga | Endoscopy Division, National Cancer Center Hospital |
| [ Summary ] | The use of gastric endoscopic submucosal dissection (ESD) has become widespread in Japan, however, there are still some unresolved issues concerning ESD. We discuss these issues based on our gastric ESD results. The first, technical difficulty：lesions in the upper or middle thirds of the stomach, larger lesions and lesions with ulcer findings are contributing factors for increased technical difficulty from the viewpoint of a lower rate of enbloc resections with tumor-free margins, longer operation times>120 minutes, more frequent decreases in Hb levels> 2 g/dl and a greater risk of perforations. The second, non-curative resections resulting from diagnostic inaccuracy：15 % of ESD patients experienced histologically non-curative resections including those with positive lateral margins only (11.5 %) and those with possible risks of lymph-node metastasis (88.5 %) because of SM2 invasion, predominantly undifferentiated type lesions, positive lymphatic and/or venous invasion, intramucosal cancers>30 mm in size with ulcer findings and SM1 lesions >30 mm in size. The third, long-term outcomes : we recently reported in a retrospective study on long-term outcomes of our ESD case series that patients who underwent ESD based on the expanded criteria had similar long-term survival rate to those treated according to the guideline criteria. However, a prospective multicenter study on long-term outcomes of gastric ESDs is essential. |
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