Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 373–381 | Cite as

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

  • Seong Woo JeonEmail author
  • Hyun Woo Park
  • Yong Hwan Kwon
  • Su Youn Nam
  • Hyun Seok Lee
Original Article



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.


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.


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.


Indication judged by pre-procedural endoscopy is not sufficiently accurate to be used as a good measurement for post-procedural criteria.


Submucosal dissection Endoscopic Stomach neoplasms Standards 


Compliance with ethical standards

Conflicts of interest

There are no financial or other conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastric Cancer CenterKyungpook National University HospitalDaeguSouth Korea
  2. 2.Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea

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