Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications

Abstract

Background: Current guidelines for endoscopic management such as EMR and endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) are in evolution, with broader indication criteria.

Objective: To determine the clinical outcomes of endoscopic treatment, based on absolute indication and extended indication criteria and endoscopic methods.

Design: Retrospective study.

Setting: Tertiary-care, academic medical center.

Patients: EMR or ESD was performed on 1627 cases of EGC in 1447 patients from July 1994 to January 2009.

Intervention: EMR and ESD.

Main outcome measurements: Clinical outcomes of EGC after EMR or ESD, based on the indication criteria.

Results: Although the complete resection rate was higher (95.9% vs 88.4%; P < .001), and the complication rate was lower (6.8% vs 9.8%; P = .054) in the absolute than in the extended indication group, there was no between-group difference in the local recurrence rate (0.9% vs 1.1%; P = .783) at a median follow-up period of 32 months (interquartile range 22-48 months). In the extended indication group, ESD resulted in a significantly higher complete resection rate than EMR (83.0% vs 91.1%; P = .006).

Limitations: Retrospective study.

Conclusion: ESD in the extended indication group showed acceptable clinical outcomes with a relatively high complete resection rate and a low local recurrence rate.