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

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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.

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Author notes

  1. Seong Woo Jeon and Hyun Woo Park have contributed equally to this wok.

Authors and Affiliations

  1. Gastric Cancer Center, Kyungpook National University Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41410, South Korea

    Seong Woo Jeon, Hyun Woo Park, Yong Hwan Kwon, Su Youn Nam & Hyun Seok Lee

  2. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea

    Seong Woo Jeon, Yong Hwan Kwon & Hyun Seok Lee

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  1. Seong Woo Jeon
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  2. Hyun Woo Park
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Correspondence to Seong Woo Jeon.

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Jeon, S.W., Park, H.W., Kwon, Y.H. et al. Endoscopic Indication of Endoscopic Submucosal Dissection for Early Gastric Cancer Is Not Compatible with Pathologic Criteria in Clinical Practice. Dig Dis Sci 64, 373–381 (2019). https://doi.org/10.1007/s10620-018-5324-9

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  • DOI: https://doi.org/10.1007/s10620-018-5324-9

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