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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.
Gastric cancer is the most common cancer worldwide and it is often diagnosed in an advanced stage. In countries where screening endoscopy is performed widely, early detection is possible. In fact, early gastric cancer incidence is increasing during the last years worldwide and screening could be a major factor in such increase. In the past, the standard treatment of gastric cancer was surgical resection; however, the endoscopic treatment has increased due to advances in the instruments available and clinician experience. In fact, endoscopic resection has become one of the greatest advances in EGC treatment. It is the standard treatment in most of the cases because early gastric cancer is associated with a low rate of lymph node metastasis and a high survival rate. Endoscopic Mucosal Resection and more recently Endoscopic Submucosal Dissection are the two main developed procedures. Endoscopic Submucosal Dissection achieves a higher rate of en-bloc resection, complete resection, curative resection and lower local recurrence compared with Endoscopic Mucosal Resection group. The disadvantages associated with Endoscopic Submucosal Dissection, such as higher perforation rates and longer procedure time, will probably improve as the endoscopists experience increases and new endoscopic tools are developed. The aim of this paper is to review the management of EGC with a special focus on endoscopic detection, staging, therapy, surveillance, and prevention.
We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative therapy of lesions that would otherwise need surgery. Early outcomes data suggest promising results. But further long term prospective studies are needed.