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Endoscopic Indication of Endoscopic Submucosal Dissection for Early Gastric Cancer Is Not Compatible with Pathologic Criteria in Clinical Practice

  • Seong Woo Jeon
  • Hyun Woo Park
  • Yong Hwan Kwon
  • Su Youn Nam
  • Hyun Seok Lee
Original Article
  • 46 Downloads

Abstract

Background

The inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to additional surgery because of a non-curative resection. This study was performed to assess the accuracy of clinical decisions in ESD for EGC.

Methods

A total of 607 cases of EGC treated by ESD were prospectively enrolled from January 2011 to June 2014 at a single academic hospital. The 607 EGCs were divided into three groups (overestimated, same-estimated, and underestimated) based on pre-procedure endoscopic findings (indication) and pathological diagnosis after ESD (criteria). We evaluated the discrepancy rates between pre-procedure indication and pathological criteria, and then analyzed the pre-procedure factors that could influence the occurrence of the discrepancies.

Results

The absolute, expanded, and beyond the expanded indication has its accuracy on curability criteria in 87%, 77.6%, and 55.6% of cases, respectively. The ratio of overall indication-criteria discrepancies was 250/607 (41.2%). The curability was significantly lower in the underestimated group compared to the overestimated and same-estimated groups (41.6% vs. 94.6%, 94.4%, p < 0.001). In multivariate analysis examining the predictive factors for discrepancies in the 598 EGCs with absolute/expanded indications, the endoscopic size ≥ 20 mm [odds ratio (OR) 2.493, confidence interval (CI) 1.546–4.022, p < 0.001], presence of ulcers (OR 1.712, CI 1.070–2.738, p = 0.025), patient age < 60 years (OR 1.689, CI 1.044–2.733, p = 0.033), and undifferentiated type EGC on forceps biopsy (OR 5.397, CI 2.027–14.369, p = 0.001) were all associated with discrepancies.

Conclusions

Indication judged by pre-procedural endoscopy is not sufficiently accurate to be used as a good measurement for post-procedural criteria.

Keywords

Submucosal dissection Endoscopic Stomach neoplasms Standards 

Notes

Compliance with ethical standards

Conflicts of interest

There are no financial or other conflicts of interest to disclose.

References

  1. 1.
    Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–229.CrossRefGoogle Scholar
  2. 2.
    Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–942.CrossRefGoogle Scholar
  3. 3.
    Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–883.CrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112.CrossRefGoogle Scholar
  5. 5.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  6. 6.
    Abdelfatah MM, Barakat M, Lee H, et al. The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis. Gastrointest Endosc. 2018;87:338–347.CrossRefGoogle Scholar
  7. 7.
    Shin KY, Jeon SW, Cho KB, et al. Clinical outcomes of the endoscopic submucosal dissection of early gastric cancer are comparable between absolute and new expanded criteria. Gut Liver. 2015;9:181–187.CrossRefGoogle Scholar
  8. 8.
    Shim CN, Song MK, Kang DR, et al. Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer. Surg Endosc. 2014;28:2199–2207.CrossRefGoogle Scholar
  9. 9.
    Toyokawa T, Inaba T, Omote S, et al. Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol. 2012;27:907–912.CrossRefGoogle Scholar
  10. 10.
    Kim M, Jeon SW, Cho KB, et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surg Endosc. 2013;27:1372–1378.CrossRefGoogle Scholar
  11. 11.
    Kim JM, Sohn JH, Cho MY, et al. Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA–Korea ESD for Early Gastric Cancer Prospective Study (N-Keep). Gastric Cancer. 2016;19:1104–1113.CrossRefGoogle Scholar
  12. 12.
    Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28:3–15.CrossRefGoogle Scholar
  13. 13.
    Flejou JF. WHO classification of digestive tumors: the fourth edition. Ann Pathol. 2011;31:S27–S31.CrossRefGoogle Scholar
  14. 14.
    Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–S43.CrossRefGoogle Scholar
  15. 15.
    Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.CrossRefGoogle Scholar
  16. 16.
    Zhou Y, Li XB. Endoscopic prediction of tumor margin and invasive depth in early gastric cancer. J Dig Dis. 2015;16:303–310.CrossRefGoogle Scholar
  17. 17.
    Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–336.CrossRefGoogle Scholar
  18. 18.
    Yanai H, Noguchi T, Mizumachi S, et al. A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut. 1999;44:361–365.CrossRefGoogle Scholar
  19. 19.
    Lee JH, Cho JY, Choi MG, et al. Usefulness of autofluorescence imaging for estimating the extent of gastric neoplastic lesions: a prospective multicenter study. Gut Liver. 2008;2:174–179.CrossRefGoogle Scholar
  20. 20.
    Lee TH, Cho JY, Chang YW, et al. Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type. Gastrointest Endosc. 2010;71:920–926.CrossRefGoogle Scholar
  21. 21.
    Choi CW, Kim HW, Shin DH, et al. The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion (low grade dysplasia). Dig Dis Sci. 2014;59:421–427.  https://doi.org/10.1007/s10620-013-2874-8.CrossRefPubMedGoogle Scholar
  22. 22.
    Goo JJ, Choi CW, Kang DH, et al. Risk factors associated with diagnostic discrepancy of gastric indefinite neoplasia: who need en bloc resection? Surg Endosc. 2015.  https://doi.org/10.1007/s00464-015-4151-8.CrossRefPubMedGoogle Scholar
  23. 23.
    Kato M, Nishida T, Tsutsui S, et al. Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group. J Gastroenterol. 2011;46:325–331.CrossRefGoogle Scholar
  24. 24.
    Min BH, Kang KJ, Lee JH, et al. Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimen-based diagnosis. Dig Dis Sci. 2014;59:2536–2543.  https://doi.org/10.1007/s10620-014-3196-1.CrossRefPubMedGoogle Scholar
  25. 25.
    Cho SJ, Choi IJ, Kim CG, et al. Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy. 2011;43:465–471.CrossRefGoogle Scholar
  26. 26.
    Kim JH, Song KS, Youn YH, et al. Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer. Gastrointest Endosc. 2007;66:901–908.CrossRefGoogle Scholar
  27. 27.
    Nakayoshi T, Tajiri H, Matsuda K, et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy. 2004;36:1080–1084.CrossRefGoogle Scholar
  28. 28.
    Li HY, Dai J, Xue HB, et al. Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study. Gastrointest Endosc. 2012;76:1124–1132.CrossRefGoogle Scholar
  29. 29.
    Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer. 2008;11:134–148.CrossRefGoogle Scholar
  30. 30.
    Matsuo K, Takedatsu H, Mukasa M, et al. Diagnosis of early gastric cancer using narrow band imaging and acetic acid. World J Gastroenterol. 2015;21:1268–1274.CrossRefGoogle Scholar
  31. 31.
    Kobara H, Mori H, Fujihara S, et al. Prediction of invasion depth for submucosal differentiated gastric cancer by magnifying endoscopy with narrow-band imaging. Oncol Rep. 2012;28:841–847.CrossRefGoogle Scholar
  32. 32.
    Choi J, Kim SG, Im JP, et al. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy. 2010;42:705–713.CrossRefGoogle Scholar
  33. 33.
    Park SH, Sung SH, Lee SJ, et al. The clinical accuracy of endoscopic ultrasonography and white light imaging in gastric endoscopic submucosal dissection. J Gastric Cancer. 2012;12:99–107.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastric Cancer CenterKyungpook National University HospitalDaeguSouth Korea
  2. 2.Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea

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