TY - JOUR
T1 - Endoscopic Indication of Endoscopic Submucosal Dissection for Early Gastric Cancer Is Not Compatible with Pathologic Criteria in Clinical Practice
AU - Jeon, Seong Woo
AU - Park, Hyun Woo
AU - Kwon, Yong Hwan
AU - Nam, Su Youn
AU - Lee, Hyun Seok
N1 - Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/2/15
Y1 - 2019/2/15
N2 - 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.
AB - 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.
KW - Endoscopic
KW - Standards
KW - Stomach neoplasms
KW - Submucosal dissection
UR - http://www.scopus.com/inward/record.url?scp=85055091050&partnerID=8YFLogxK
U2 - 10.1007/s10620-018-5324-9
DO - 10.1007/s10620-018-5324-9
M3 - Article
C2 - 30311155
AN - SCOPUS:85055091050
SN - 0163-2116
VL - 64
SP - 373
EP - 381
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 2
ER -