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. 2016 Jan;10(1):42-50.
doi: 10.5009/gnl14401.

Therapeutic Decision-Making Using Endoscopic Ultrasonography in Endoscopic Treatment of Early Gastric Cancer

Jong Yeul Lee  1 , Il Ju Choi  1 , Chan Gyoo Kim  1 , Soo-Jeong Cho  1 , Myeong-Cherl Kook  1 , Keun Won Ryu  1 , Young-Woo Kim  1
Affiliations

Therapeutic Decision-Making Using Endoscopic Ultrasonography in Endoscopic Treatment of Early Gastric Cancer

Jong Yeul Lee et al. Gut Liver. 2016 Jan.

Abstract

Background/aims: We evaluated the effectiveness of an endoscopic ultrasonography (EUS)-based treatment plan compared to an endoscopy-based treatment plan in selecting candidates with early gastric cancer (EGC) for endoscopic submucosal dissection based on the prediction of invasion depth.

Methods: We reviewed 393 EGCs with differentiated histology from 380 patients who underwent EUS from July 2007 to April 2010. The effectiveness of the EUS-based and endoscopy-based plans was evaluated using a simplified hypothetical treatment algorithm.

Results: The numbers of endoscopically determined mucosal, indeterminate, and submucosal cancers were 253 (64.4%), 56 (14.2%), and 84 (21.4%), respectively. Overall, the appropriate treatment selection rates were 75.3% (296/393) in the endoscopy-based plan and 71.5% (281/393) in the EUS-based plan (p=0.184). For endoscopic mucosal cancers, the appropriate treatment selection rates in the endoscopy-based plan were 88.1% (223/253), while the use of an EUS-based plan significantly decreased this rate to 81.4% (206/253) (p=0.036). For endoscopic submucosal cancers, the appropriate selection rates did not differ between the endoscopy-based plan (46.4%, 39/84) and the EUS-based plan (53.6%, 45/84) (p=0.070).

Conclusions: EUS did not increase the likelihood of selecting the appropriate treatment in differentiated-type EGC. Therefore, EUS may not be necessary before treating differentiated-type EGC, especially in endoscopically presumed mucosal cancers.

Keywords: Conventional endoscopy; Early gastric cancer; Endoscopic submucosal dissection; Endosonography.

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Figures

Fig. 1
Fig. 1
Endoscopic assessment of the depth of invasion in early gastric cancers. Protruding lesions with a smooth surface (A), as well as shallow, depressed, or flat lesions with a smooth surface (B) were considered mucosal cancers. Lesions with an uneven, stiffened base and irregularly shaped nodules or those with enlarged or fused folds (C, D) were considered submucosal cancers. Lesions with ambiguous morphologies were classified as indeterminate cancers (E, F).
Fig. 2
Fig. 2
Flowchart of hypothetical treatment selection in the endoscopy-based or the endoscopic ultrasonography (EUS)-based plans. This figure shows the results of hypothetical treatment selection according to endoscopy-based or EUS-based plans, generated by a simplified hypothetical treatment algorithm. EGC, early gastric cancer; ESD, endoscopic submucosal dissection.
See this image and copyright information in PMC

Comment in

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