Curative Endoscopic Submucosal Dissection for Recurrent Gastric Cancer

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Summary and Comment

Curative Endoscopic Submucosal Dissection for Recurrent Gastric Cancer

ESD can be used after EMR in patients with local gastric cancer recurrences.

Endoscopic mucosal resection (EMR) is used widely in Japan as curative therapy for small early gastric cancers. It is less successful when lesions are large and require piecemeal resection, and scarring often prevents EMR retreatment of local recurrences. Endoscopic submucosal dissection (ESD) is a different technique that allows en bloc resection of large sections of mucosa.

Investigators in Japan retrospectively evaluated their results with either EMR or ESD for resection of locally recurrent gastric cancer. They identified 64 patients with recurrent cancer after EMR therapy. Eighteen of these patients underwent repeat resection using EMR, and the other 46 were treated with ESD.

Pathologic examination of the resected specimens showed that en bloc resection was successful in 41 patients who were treated with ESD but in no patients who received repeat EMR. An intent-to-treat analysis showed that curative resection (defined as clean margins, lack of penetration, and no lymphatic or vascular involvement) was achieved in 76% of the ESD group and in 33% of the EMR group. None of the patients with curative resection had local recurrence after an average follow-up of 43 months. No major bleeding occurred, but perforations occurred in four patients, who were treated with endoscopic clips, nasogastric suction, and antibiotic therapy. The authors concluded that ESD is safe and efficacious for en bloc curative resection in patients with recurrent gastric cancer.

Comment: Results from this retrospective study from an expert center in Japan might not be generalizable to other situations. They are particularly challenging to incorporate into endoscopic treatment of gastric cancer in countries such as the U.S., where early gastric cancers often are not diagnosed.

— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Published in Journal Watch Gastroenterology October 6, 2006

Citation(s):

Yokoi C et al. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006 Aug; 64:212-8.