Search

Objective: The criteria for endoscopic resection for early gastric cancer include absolute and expanded indications. Consensus already exists for the absolute indications. However, the suitability of the expanded indications must be validated by long-term outcome analyses since such lesions have only recently become resectable with the development of endoscopic submucosal dissection. The aim of this study is to clarify the suitability of the expanded indications for the treatment of early gastric cancer with endoscopic submucosal dissection., Materials and Methods: The medical records of 1161 patients with early gastric cancers (1332 lesions) treated by endoscopic submucosal dissection and meeting the criteria for absolute or expanded indications without additional treatment with gastrectomy were divided into absolute indication group or expanded indication group., Results: Complete resection rates were 96.4% and 93.4% in absolute and expanded indication groups, respectively, with no significant differences between the groups. Delayed bleeding rates were significantly higher in the expanded indication group, whereas all cases were successfully managed conservatively. The 5-year overall survival and recurrence-free rates were 93.7%/99.77% and 90.49%/98.90% in the absolute and the expanded indication groups, respectively, with no significant differences between the groups for either measure. Multivariate analyses revealed that affected horizontal margin and tumor location were independent predictive factors for recurrence., Conclusion: The expanded indication group showed excellent post-endoscopic submucosal dissection short-term and long-term outcomes compared with the absolute indications group, demonstrating that expanded indications are suitable for endoscopic submucosal dissection for early gastric cancer.

Background and Aims: There is no evidence of postoperative metastasis of gastric gastrointestinal stromal tumors (GISTs) smaller than 2 cm. The aim of this study was to evaluate the clinical usefulness of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) for gastric subepithelial lesions (SELs) smaller than 2 cm., Patients and Methods: Using a prospectively maintained EUS-FNA database, 90 consecutive EUS-FNAs of gastric hypoechoic solid SELs smaller than 2 cm diagnosed by EUS were evaluated retrospectively. The reference standards for the final diagnosis were surgery (n=44) and/or clinical follow-up (n=46) using esophagogastroduodenoscopy (EGD), CT, and/or ultrasonography (US). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared., Results: The diagnostic rate of EUS-FNA for gastric hypoechoic solid SELs smaller than 2 cm was 73% (66/90). Histological diagnosis of EUS-FNA showed 47 (52%) malignant SELs (44 GISTs, 1 glomus tumor, 1 SEL like cancer, and 1 malignant lymphoma), 19 (21%) benign SELs (14 leiomyomas, 4 ectopic pancreas, and 1 neurinoma), and 24 (27%) indeterminate SELs. In 44 surgically resected cases, the diagnostic accuracy of EUS-FNA using immunohistochemical analysis was 98% (43/44). There were no complications. Appropriate management was performed in 65 out of 66 SELs (98%) diagnosed by definitive EUS-FNA. After surgery, there was no recurrence of malignant SELs., Conclusions: EUS-FNA is an accurate and safe method in the pre-therapeutic diagnosis of gastric SELs smaller than 2 cm. EUS-FNA for gastric SELs smaller than 2 cm is a promising way to permit early management of patients with gastric SELs including GIST.

A glomus tumor of the stomach is rare. It is difficult to diagnose the tumor before surgery by only endoscopic biopsy and radiography, and there is no established method of diagnosis before surgical treatment. Esophagogastroduodenoscopy (EGD) on a 50-year-old Japanese woman revealed a 10 mm submucosal tumor in the anterior wall of the gastric angle. Follow-up EGD revealed an increase in the size of the tumor to 15mm. Endoscopic ultrasonography (EUS) demonstrated a 15mm subepithelial hypoechoic solid tumor with continuity to the proper muscle layer. Histologic diagnosis by endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) was glomus tumor. The tumor was treated by laparoscopic local resection. The histologic diagnosis of the resected tumor was similar to the preoperative EUS-FNA results. EUS-FNA would appear to be an effective histologic test for early diagnosis of gastric glomus tumor.

Background and Aim: Endoscopic submucosal dissection (ESD) is now accepted as a minimally invasive treatment for early gastric cancer (EGC). To our knowledge, however, the functional effects of ESD have not been determined in patients with EGC. We therefore investigated whether gastric motility was affected by ESD., Methods: Using the (13) C-octanoic acid breath test, gastric emptying of solid test meals was examined in 26 EGC patients and 18 healthy controls, with EGC patients assayed before and about 2 months after ESD. Based on (13) CO2 breath-excretion curves, the lag-phase time (T(lag) ), half-emptying time (T(1/2) ), and gastric emptying coefficient (GEC) were calculated as indices of gastric emptying., Results: In healthy controls, the mean T(lag), T(1/2), and GEC were 85.5 ± 4.9 min, 148.5 ± 8.0 min, and 3.01 ± 0.09 h, respectively. Before ESD, the mean T(lag) , T(1/2), and GEC in the EGC patients were 90.1 ± 5.5 min, 174.7 ± 10.4 min, 2.64 ± 0.08 h, respectively. GEC, but not T(lag) or T(1/2), differed significantly in the two groups, with gastric emptying slower in EGC patients than in controls. Relative to before ESD, the mean T(lag), T(1/2), and GEC in EGC patients after ESD were 109.2% ± 7.8%, 107.9% ± 9.6%, 108.4% ± 4.7%, respectively, indicating that ESD did not significantly affect any of these gastric emptying parameters in EGC patients., Conclusion: ESD is an effective treatment for EGC both in preserving organs and gastric motility., (© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)

Aim: To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed a new grasping-type scissors forceps (GSF) that can grasp and incise the target tissue using electrosurgical current. The aim of the present study was to evaluate the efficacy and safety of ESD using GSF for the removal of early gastric cancers and adenomas., Methods: ESD using GSF was carried out on 35 consecutive patients with early gastric cancers or adenomas who had preoperative EUS diagnoses of mucosal tumor without lymph node involvement. Therapeutic efficacy and safety were assessed., Results: All lesions were treated easily and safely without unexpected incision. The mean size of epithelial tumors and resected specimens was 15.6mm and 32.7mm, respectively. Curative en-bloc resection rates according to tumor size and location were 96% (26/27) in tumors ≤20mm, 100% (8/8) in tumors >20mm, 100% (18/18) of tumors in the lower portion, 100% (8/8) of tumors in the middle portion, 89% (8/9) of tumors in the upper portion, and 97% (34/35) overall. The mean operating time according to tumor size and location was 93.4min in tumors ≤20mm, 140min in tumors >20mm, 77.6min for tumors in the lower portion, 113.4min for tumors in the middle portion, 148.6min for tumors in the upper portion, and 104.1min overall. No intraoperative complication occurred, and postoperative bleeding was seen in 3% (1/35)., Conclusions: ESD using GSF allows simple and safe en-bloc resection of early gastric cancer or adenoma irrespective of tumor size and location., (© 2010 The Authors. Digestive Endoscopy © 2010 Japan Gastroenterological Endoscopy Society.)

Background: Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcoming of this method is the difficulty of fixing the knife to the target lesion. It can lead to an unexpected incision and result in major complications, such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping-type scissors forceps (GSF), which can grasp and incise the targeted tissue by using electrosurgical current., Objective: To evaluate the efficacy and safety of ESD by using GSF for the removal of gastric neoplasms in human beings., Design: Prospective, uncontrolled, single center., Setting: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan., Patients: Four patients with early gastric neoplastic lesions., Interventions: After marking and injection of a solution into the submucosa, the lesion was separated from the surrounding normal mucosa by complete incision around the lesion by using the GSF. A piece of submucosal tissue was grasped and cut with the GSF by using electrosurgical current to achieve submucosal excision., Main Outcome Measurement: Technical success and complications., Results: All lesions were treated easily and safely, without any unexpected incisions. No delayed hemorrhage and perforation occurred. An en bloc resection and a negative resection margin was obtained in all cases., Limitations: The small number of patients and an uncontrolled study., Conclusions: ESD with GSF appeared to be an easy, safe, and technically efficient method for resecting GI neoplasms.