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. 2013:2013:329385.
doi: 10.1155/2013/329385. Epub 2013 Mar 28.

Prospective Study about the Utility of Endoscopic Ultrasound for Predicting the Safety of Endoscopic Submucosal Dissection in Early Gastric Cancer (T-HOPE 0801)

Daisuke Kikuchi  1 , Toshiro Iizuka, Shu Hoteya, Akihiro Yamada, Tsukasa Furuhata, Satoshi Yamashita, Kaoru Domon, Masanori Nakamura, Akira Matsui, Toshifumi Mitani, Osamu Ogawa, Mitsuru Kaise
Affiliations

Prospective Study about the Utility of Endoscopic Ultrasound for Predicting the Safety of Endoscopic Submucosal Dissection in Early Gastric Cancer (T-HOPE 0801)

Daisuke Kikuchi et al. Gastroenterol Res Pract. 2013.

Abstract

Background. Intraoperative bleeding is an important determinant for safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to prospectively evaluate the usefulness of endoscopic ultrasound (EUS) for predicting ESD safety. Methods. A total of 110 patients with EGC were divided into two groups based on EUS findings: group P, almost no blood vessels in submucosa, or ≤4 small vessels per field of view; group R, remaining patients. Primary endpoint was the decrease in Hb after ESD. Secondary endpoints included procedure time and the incidence of muscle injury and clip use. Results. A total of 89 patients were evaluated. Fifty were classified into group P and 39 into group R. Mean decrease in Hb was 0.27 g/dL in group P and 0.35 g/dL in group R, with no significant difference. Mean procedure time was significantly longer in group R (105.4 min) than in group P (65.5 min) (P < 0.001). The incidence of muscle injury and clip use were significantly higher in group R (25.6%/48.7%) than in group P (8.0%/20.0%) (P = 0.02/P = 0.004). Conclusion. Preoperative EUS can predict procedure time and the incidence of muscle injury and clip use and is thus considered useful for predicting gastric ESD safety.

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Figures

Figure 1
Figure 1
Flow of patients through this study.
Figure 2
Figure 2
Endoscopic image of a patient in group P showing a flat elevated lesion on the posterior wall of the middle gastric body (yellow arrow).
Figure 3
Figure 3
EUS image of the lesion of Figure 2. EUS showing no hypoechoic area suggestive of blood vessels in the third layer.
Figure 4
Figure 4
Post-ESD image of the lesion of Figure 2. There is no carbide on ESD ulcer.
Figure 5
Figure 5
Endoscopic image of a patient in group R showing a depressed lesion on the posterior wall of the lower gastric body (yellow arrow).
Figure 6
Figure 6
EUS image of the lesion of Figure 5. EUS showing some large vessels approximately 1000 μm in diameter in the third layer (yellow arrow).
Figure 7
Figure 7
Post-ESD image of the lesion of Figure 5. A lot of carbide by hemostatic forceps and muscle injury were recognized on ESD ulcer.
See this image and copyright information in PMC

References

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