Clinical Impact of Endoscopic Submucosal Dissection for Early Gastric Cancer


Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.

Share and Cite:

T. Kosaka, M. Endo, Y. Toya, T. Mizutani, Y. Abiko, N. Kudara, M. Inomata, T. Chiba, Y. Takikawa, K. Suzuki and T. Sugai, "Clinical Impact of Endoscopic Submucosal Dissection for Early Gastric Cancer," Journal of Cancer Therapy, Vol. 4 No. 1A, 2013, pp. 61-67. doi: 10.4236/jct.2013.41A009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. Endo, M. Inomata, T. Terui, S. Oana, N. Kudara, H. Obara, Y. Hashimoto, T. Chiba, S. Orii and K. Suzuki. “New Endoscopic Technique to Close Large Mucosal Defects after Endoscopic Mucosal Resection in Patients with Gastric Mucosal Tumors,” Digestive Endoscopy, Vol. 16, No. 4, 2004, pp. 372-375. doi:10.1111/j.1443-1661.2004.00410.x
[2] M. Endo, M. Higuchi, T. Chiba, K. Suzuki and Y. Inoue, “Present State of Endoscopic Hemostasis for Nonvariceal Upper Gastrointestinal Bleeding,” Digestive Endoscopy, Vol. 22, No. 1, 2010, pp. 31-34. doi:10.1111/j.1443-1661.2010.00976.x
[3] S. Oka, S. Tanaka, I. Kaneko, R. Mouri, M. Hirata, T. Kawamura, M. Yoshihara and K. Chayama. “Advantage of Endoscopic Submucosal Dissection Compared with EMR for Early Gastric Cancer,” Gastrointestinal Endoscopy, Vol. 64, No. 6, 2006, pp. 877-883. doi:10.1016/j.gie.2006.03.932
[4] I. Oda, D. Saito, M. Tada, H. Iishi, S. Tanabe, T. Oyama, T. Doi, Y. Otani, J. Fujisaki, Y. Ajioka, T. Hamada, H. Inoue, T. Gotoda and S. Yoshida, “A Multicenter Retrospective Study of Endoscopic Resection for Early Gastric Cancer,” Gastric Cancer, Vol. 9, No. 4, 2006, pp. 262-270. doi:10.1007/s10120-006-0389-0
[5] S. Nonaka, I. Oda, T. Nakaya, C. Kusano, H. Suzuki, S. Yoshinaga, T. Fukagawa, H. Katai and T. Gotoda. “Clinical Impact of a Strategy Involving Endoscopic Submucosal Dissection for Early Gastric Cancer: Determining the Optimal Pathway,” Gastric Cancer, Vol. 14, No. 1, 2011, pp. 56-62. doi:10.1007/s10120-011-0008-6
[6] J. Y. Ahn, H.-Y. Jung, K. D. Choi, J. Y. Choi, M.-Y. Kim, J. H. Lee, K.-S. Choi, D. H. Kim, H. J. Song, G. H. Lee, J.-H. Kim and Y. S. Park. “Endoscopic and Oncologic Outcomes after Endoscopic Resection for Early Gastric Cancer: 1370 Cases of Absolute and Extended Indications,” Gastrointestinal Endoscopy, Vol. 74, No. 3, 2011, pp. 485-493. doi:10.1016/j.gie.2011.04.038
[7] J. S. Jang, S. R. Choi, W. Qureshi, M. C. Kim, S. J. Kim, J. S. Jeung, S. Y. Han, M. H. Noh, J. H. Lee, S. W. Lee, Y. H. Baek, S. H. Kim and P. J. Choi, “Long-Term Outcomes of Endoscopic Submucosal Dissection in Gastric Neoplastic Lesions at a Single Institution in South Korea,” Scandinavian Journal of Gastroenterology, Vol. 44, No. 11, 2009, pp. 1315-1322. doi:10.3109/00365520903254304
[8] T. Sano and Y. Kodera, “Japanese Gastric Cancer Treatment Guidelines 2010 (Ver. 3),” Gastric Cancer, Vol. 14, No. 2, 2011, pp. 113-123. doi:10.1007/s10120-011-0042-4
[9] T. Gotoda, A. Yanagisawa, M. Sasako, H. Ono, Y. Nakanishi, T. Shimoda and Y. Kato, “Incidence of Lymph Node Metastasis from Early Gastric Cancer: Estimation with a Large Number of Cases at Two Large Centers,” Gastric Cancer, Vol. 3, No. 4, 2000, pp. 219-225. doi:10.1007/PL00011720
[10] N. Yahagi, M. Fujishiro, N. Kakushima, K. Kobayashi, T. Hashimoto, M. Oka, M. Iguchi, S. Enomoto, M. Ichinose, H. Niwa and M. Omata, “Endoscopic Submucosal. Dissection for Early Gastric Cancer Using the Tip of an Electrosurgical Snare (Thin Type),” Digestive Endoscopy, Vol. 16, No. 1, 2004, pp. 34-38. doi:10.1111/j.1443-1661.2004.00313.x
[11] H. Yamamoto, T. Yube, N. Isoda, Y. Sato, Y. Sekine, T. Higashizawa, K. Ido, K. Kimura and N. Kanai, “A Novel Method of Endoscopic Mucosal Resection Using Sodium Hyaluronate,” Gastrointestinal Endoscopy, Vol. 50, No. 2, 1999, pp. 251-256. doi:10.1016/S0016-5107(99)70234-8
[12] H. Ono, H. Kondo, T. Gotoda, K. Shirao, H. Yamaguchi, D. Saito, K. Hosokawa, T. Shimoda and S. Yoshida “Endoscopic Mucosal Resection for Treatment of Early Gastric Cancer,” Gut, Vol. 48, No. 2, 2001, pp. 225-229. doi:10.1136/gut.48.2.225
[13] H. Ono, N. Hasuike, T. Inui, K. Takizawa, H. Ikehara, Y. Yamaguchi, Y. Otake and H. Matsubayashi “Usefulness of a Novel Electrosurgical Knife, the Insulation-Tipped Diathermic Knife-2, for Endoscopic Submucosal Dissection of Early Gastric Cancer,” Gastric Cancer, Vol. 11, No. 1, 2008, pp. 47-52. doi:10.1007/s10120-008-0452-0
[14] T. Oyama and Y. Kikuchi. “Aggressive Endoscopic Mucosal Resection in the Upper GI Tract-Hook Knife EMR Method,” Minimally Invasive Therapy and Allied Technologies, Vol. 11, No. 5-6, 2002, pp. 291-295.
[15] T. Sano and Y. Kodera, “Japanese Classification of Gastric Carcinoma: 3rd English Edition,” Gastric Cancer, Vol. 14, No. 2, 2011, pp. 101-112. doi:10.1007/s10120-011-0041-5
[16] I. Oda, T. Odagaki, H. Suzuki, S. Nonaka and S. Yoshinaga “Learning Curve for Endoscopic Submucosal Dissection of Early Gastric Cancer Based on Trainee Experience,” Digestive Endoscopy, Vol. 24, No. 1, 2012, pp. 129-132. doi:10.1111/j.1443-1661.2012.01265.x
[17] T. Gotoda, M. Iwasaki, C. Kusano, S. Seewald and I. Oda “Endoscopic Resection of Early Gastric Cancer Treated by Guideline and Expanded National Cancer Centre Criteria,” British Journal of Surgery, Vol. 97, No. 6, 2010, pp. 868-871. doi:10.1002/bjs.7033
[18] H. Lee, W. K. Yun, B. H. Min, J. H. Lee, P. L. Rhee, K. M. Kim, J. C. Rhee and J. J. Kim, “A Feasibility Study on the Expanded Indication for Endoscopic Submucosal Dissection of Early Gastric Cancer,” Surgical Endoscopy, Vol. 25, No. 6, 2011, pp. 1985-1993. doi:10.1007/s00464-010-1499-7
[19] N. Hanaoka, S. Tanabe, T. Mikami, I. Okayasu and K. Saigenji, “Mixed-Histologic-Type Submucosal Invasive Gastric Cancer as a Risk Factor for Lymph Node Metastasis: Feasibility of Endoscopic Submucosal Dissection,” Endoscopy, Vol. 41, No. 5, 2009, pp. 427-432. doi:10.1055/s-0029-1214495
[20] K. Okada, J. Fujisaki, T. Yoshida, H. Ishikawa, T. Suganuma, A. Kasuga, M. Omae, A. Ishiyama, T. Hirasawa, A. Chino, M. Inamori, Y. Yamamoto, N. Yamamoto, T. Tsuchida, Y. Tamegai, A. Nakajima, E. Hoshino and M. Igarashi, “Long-Term Outcomes of Endoscopic Submucosal Dissection for Undifferentiated-Type Early Gastric Cancer,” Endoscopy, Vol. 44, No. 2, 2012, pp. 122-127. doi:10.1055/s-0031-1291486
[21] I. Oda, T. Shimizu, H. Ono, S. Tanabe, H. Iishi, H. Kondo and M. Ninomiya, “Design of Japanese Multicenter Prospective Cohort Study of Endoscopic Resection for Early Gastric Cancer Using Web Registry (J-WEB/ EGC),” Gastric Cancer, Vol. 15, No. 4, 2012, pp. 451-454. doi:10.1007/s10120-012-0159-0

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.