Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer

7 years of experience in a Western tertiary cancer center

Authors

  • Ernesto Quaresma Mendonça Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Unidade de Endoscopia Gastrointestinal
  • Fernanda Cristina Simões Pessorrusso Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Unidade de Endoscopia Gastrointestinal
  • Marcus Fernando Kodama Pertille Ramos Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Departamento de Gastroenterologia
  • Carlos Eduardo Jacob Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Joel Fernandez de Oliveira Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Unidade de Endoscopia Gastrointestinal
  • Maria Sylvia Ribeiro Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Unidade de Endoscopia Gastrointestinal
  • Adriana Safatle-Ribeiro Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Unidade de Endoscopia Gastrointestinal
  • Bruno Zilberstein Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Departamento de Gastroenterologia
  • Ulysses Ribeiro Júnior Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Departamento de Gastroenterologia
  • Fauze Maluf-Filho Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas. Instituto do Cancer do Estado de Sao Paulo. Unidade de Endoscopia Gastrointestinal

DOI:

https://doi.org/10.6061/clinics/2018/e553s

Keywords:

Endoscopic Mucosal Resection, Stomach Neoplasms, Gastrointestinal Endoscopy

Abstract

OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher’s exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with ‘‘only-by-size’’ expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.

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Published

2019-02-14

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Original Articles

How to Cite

Mendonça, E. Q., Pessorrusso, F. C. S., Ramos, M. F. K. P., Jacob, C. E., Oliveira, J. F. de, Ribeiro, M. S., Safatle-Ribeiro, A., Zilberstein, B., Ribeiro Júnior, U., & Maluf-Filho, F. (2019). Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center. Clinics, 73(Suppl. 1), e553s. https://doi.org/10.6061/clinics/2018/e553s