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Endoscopic Submucosal Dissection of Gastric Lesions

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Endoscopic resection (ER) including endoscopic submucosal dissection (ESD) has become a mainstream less-invasive treatment option with similar results to gastrectomy with lymph node dissection for early gastric cancers (EGC) with a very low risk for lymph node metastasis (LNM). In Japanese guidelines, the curability after ER for EGC is classified into three groups: curative resection, expanded resection, and non-curative resection according to the estimated risk of LNM. In curative resection and expanded resection, scheduled surveillance gastroscopy is recommended for detecting metachronous EGC in Japan. On the other hand, gastrectomy with lymph node dissection is recommended in patients with some types of expanded resection (ulcerated, undifferentiated histology including mixed-type histology or slight submucosal invasion) in Western countries considering the potential risk of LNM. In non-curative resection after ER, gastrectomy with lymph node dissection is strongly proposed as the standard treatment strategy because of the higher risk for LNM. Gastric cancer is now considered a disease of the elderly population because of decreasing prevalence of Helicobacter pylori (H. pylori) infection. Thus, considering the relatively low rate of LNM, surgical treatment according to the guideline in all elderly patients may be excessive. Although gastrectomy with lymph node dissection reduce cancer-specific mortality, surgical treatment might result in worse quality of life (QOL) especially in elderly patients. Recently, risk-scoring systems for LNM may be helpful to decide the treatment option in such patients with non-curative resection after ER. Although permanent “cure” of cancer is absolutely important, in our clinical practice, many factors can affect treatment options, such as the patient’s age, potential adverse events, or the patient’s preferences. Of course, it should be noted that, when recurrence is detected in patients who were followed up with no additional treatment after ESD with non-curative resection, most of them have a poor prognosis. To select an appropriate treatment option, especially in elderly patients with non-curative ER, a new tool for evaluating the condition of patients should be established.

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Abbreviations

ASA-PS:

American Society of Anesthesiologists’ Physical Status

CI:

Confidence interval

DSS:

Disease-specific survival

EGC:

early gastric cancers

EMR:

Endoscopic mucosal resection

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

H. pylori:

Helicobacter pylori

JGCA:

Japanese Gastric Cancer Association

LNM:

Lymph node metastasis

OR:

Odds ratio

OS:

Overall survival

pT1b(SM):

Tumor invasion into the submucosa

pT1b(SM1):

A submucosal invasion depth of <500 μm

pT1b(SM2):

Tumor invasion into the submucosa ≥500 μm from the muscularis mucosa

QOL:

Quality of life

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Conflicts of Interest

No potential conflict of interest relevant to this chapter is reported.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan

    Takuji Gotoda

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  1. Takuji Gotoda
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Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Cancer Center, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

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Gotoda, T. (2021). Endoscopic Submucosal Dissection of Gastric Lesions. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_11-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_11-1

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