Tu1696 Safety of Endoscopic Submucosal Dissection for Esophageal Cancer in Elderly Patients Akiko Ono*, Ken Ohata, Takafumi Ito, Hideyuki Chiba, Yosuke Tsuji, Nobuyuki Matsuhashi Gastroenterology, NTT Medical Center Tokyo, Shinagawa-ku Tokyo, Japan Background and Aims: Endoscopic submucosal Dissection (ESD) is an noninvasive treatment for early esophageal cancer. With increasing elderly population, the number of those who need esophageal ESD has increased. However, the safety of ESD for elderly patient is still unclear. The aim of this study was to investigate the treatment outcome and evaluate the safety of ESD in patients over 75 years old. Methods: Between July 2007 and February 2011, 149 patients underwent esophageal ESD for early esophageal cancer in NTT Medical Center Tokyo. 29 patients were 75 y.o. or over (group A), and 120 patients were under 75 y.o. (group B). We retrospectively reviewed the medical records of each group to analyze age, underlying disease, pathological findings, complete en-bloc resection rate, size of resected tumor and specimen, operation time, length of hospital stay and complications (bleeding, perforation, fever above 38 degrees, pneumonia, infection requiring antibiotics, and hypoxemia after ESD). Results: The rate of subjects with underlying diseases was significantly higher in group A than in group B (A/B:18/36 P 0.002). Complete en-bloc resection rate was 100% in both groups. The size of the tumor (A/B:26.6/20.8mm) and the specimen (A/B:39.6/36.0mm) and operation time (A/B:68.1/60min) did not differ significantly between A and B. Complications including bleeding (A/B:0/0%), perforation (A/B:10/3.3%), fever above 38 degrees (A/B:10.3/14.2%), pneumonia(A/B:3.5/0.8%), infection requiring antibiotics (A/B:13.8/8.3%), hypoxemia after ESD(A/B:6.9/3.3%), the total length of hospital stay (A/B:7.3/ 7.6days) did not differ significantly between A and B. During follow up period (average 34 months,range:9-52), no patients died of esophageal cancer, but death for the other disease (1 cancer of other organ in each group, 1 rupture of abdominal aortic aneurysm in group A) occurred more frequently in group A. Concerning histological tumor invasion depth, 3 (10.3%) and 31 cases (25.8%) were MM/SM1/SM2 in group A and B (2/1/0 and 16/1/4 in A and B, respectively). AT was not performed for EP-LPM cases. In group A, 1 case with lymphovascular invasion among the 2MM cases underwent radiotherapy (RT), and the remaining 2 cases (MM/SM:1/1) were followed up without AT. In group B, 1 case among the 16MM cases was treated by RT, and another case was treated by chemoradiation therapy (CRT). 14 cases were followed up without AT.1 and 4 patients among the 5 SM1/SM2 cases underwent CRT and thoracoscopic surgery, respectively. All cases except for the 3 cases dead from other diseases are alive without recurrence. Conclusions: Though elderly patients have more underlying disease, the treatment outcome and complications of esophageal ESD in elderly patient were not significantly different from those in younger patients. Esophageal ESD in elderly patients can be safe and effective. Tu1697 Can the Gastric ESD Be Improved Further? A Review of Outcomes of a High Volume Institution With More Than Ten Years and Thousand Cases Experience Atsushi Hoshino*, Kazuki Sumiyama, Akira Dobashi, Tomohiko R. Ohya, Noboru Yoshimura, Hirobumi Toyoizumi, Kenichi Goda, Tomohiro Kato, Seiji Arihiro, Hisao Tajiri Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei Univesity School of Medicine, Tokyo, Japan; Department of Endoscopy, The Jikei Univesity School of Medicine, minatoku, Tokyo, Japan Background: Endoscopic submucosal dissection (ESD) allows us to radically remove mucosal-based lesions as en bloc regardless of lesion size. To date, the technique and the instrumentation have been steadily improved. Thereby, ESD is now recognized as a first-line therapeutic option for early stage gastric cancer in Japan. However, due to procedural challenges currently associated with ESD, the technique is only performed in some East Asian countries and at few restricted academic centers in Western countries. Further technical improvement is still imperative to gain the international acceptance of the procedure. However, it is unclear if the technique still leaves room for sophistication or has been already reached a plateau of the improvement after a large volume of clinical experiences. Aims: To investigate if the ESD technique could have been still improved at a high volume center with over ten years experience of ESD. Methods: Medical records and endoscopic findings of all patients who underwent gastric ESD at Jikei University hospital from Feb 2000 to May 2011 were reviewed (n 1009). The operation time, the tumor and the specimen sizes, the pathology, the en bloc resection rate, and the rate of perforation in recent 7 years (from Apr 2004 to Mar 2011) were analyzed separately for the earlier 2 yrs (n 221) and the later 5 yrs periods (n 683). The data in the later period were also yearly compared (chronologically subdivided into phase 1 to 5). Results: Overall, 840 eligible patients (213/627, earlier/later) were analyzed. The operation time of ESD has been steadily shortened thorough the entire study periods (Table 1). There were significant differences in the operation time between the earlier and the later periods (mean: 83.56/62min), and also phase 1 (mean: 70.98min, n 109) and phase 5 (mean: 41.82 min, n 114), phase 2 (mean: 70.98min, n 142) and phase 3 (mean: 70.98min, n 143), and phase 4 (mean: 70.98 min, n 114) and phase 5 in the later period (p 0.05). There were no significant differences in patients’ backgrounds and other measurements between the groups. Conclusions: The technical developments in ESD enabled the operation time to be consistently hastened in these 7 years in our institution and this trend is still under way. However, factors which had a greater contribution to the favorable outcome, are yet to be investigated.