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Sa1680 Predictive Factors Suggesting an Awkward Early Gastric Cancer Requiring a Deliberative Strategy for Endoscopic Submucosal Dissection

2011; Elsevier BV; Volume: 73; Issue: 4 Linguagem: Inglês

10.1016/j.gie.2011.03.415

1097-6779

Shusei Fukunaga, Hirohisa Machida, Nobuhide Oshitani, Masahiko Tabuchi, Fumio Tanaka, Kazuki Aomatsu, Kazunari Tominaga, Toshio Watanabe, Yasuhiro Fujiwara, Masatsugu Shiba, Tetsuo Arakawa,

Metastasis and carcinoma case studies

Endoscopic submucosal dissection (ESD) has been widely accepted as an endoscopic therapy for early gastric cancer (EGC), to obtain a precise pathological diagnosis and promising curability for EGC. As encountering the awkward lesion which is difficult to complete a procedure with single endoknife, the device should be changed out of necessity, supposing to change the strategy. Meanwhile there are few reports to examine the difficulty of gastric ESD in terms of a correlation between endoknife and the feature of the lesion. The aim of this study is to clarify the feature which predicts the difficulty of gastric ESD, based on a hypothesis that the necessity to change the endoknife suggests the difficulty of gastric ESD. Since January 2007 to October 2010, 642 patients with 774 gastric neoplasms underwent ESD at Izumiotsu City Hospital and Osaka City University Hospital. Of these, 564 patients who underwent ESD using an IT knife-2 (IT-2) which was one of most distributed endoknife, as a starting device, were included in this study. Patients were assigned in two groups as followed, Group A: completed ESD with only IT knife 2 and Group B: required another device in addition to IT-2 to complete ESD. Contributory factors for changing endoknife were retrospectively assessed in clinicopathological features, such as age, gender, tumor location, macroscopic type, presence of ulcer scar (UL), histological type, depth of tumor invasion, the size of resected specimen. There were 477 patients (357 men and 120 women; mean age, 70.4 ± 8.9 years) in Group A and 46 patients (38 men and 8 women; mean age, 68.7 ± 11.5 years) in Group B. As a result of univariate analysis, the necessity to change the endoknife in Group B was significantly higher than that in Group A with regard to the factor of tumor location at upper body (A/B: 14.9/ 56.5 %, p < 0.01), presence of UL (A/B: 9.2/ 41.3 %, p < 0.01), massive invasion of cancer (A/B: 6.9/ 23.9 %, p < 0.01), and mean size of the resected specimen (A/B: 38.9/ 47.0 mm, p < 0.01). There were no significant differences between Group A and B in the factor of age (p = 0.21), gender (p = 0.23), macroscopic type (p = 0.43) and histological type (p = 0.20). Multivariate analysis revealed that the lesion at upper body, coexistence of UL and massive invasion of cancer were independent risk factors influencing the necessity of changing device (P < 0.01, < 0.01, = 0.02, odds ratio 8.33, 9.07, 2.87, respectively). The factors, locating at upper body or coexistence with UL or massive invasion of cancer might predict to be an awkward lesion for ESD, because of the possible necessity of a second device. In attempting to perform a gastric ESD, deliberative strategy and precise endoscopic diagnosis may be required to complete it successfully.