Endoscopy 2014; 46(11): 933-940
DOI: 10.1055/s-0034-1377348
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal

Pedro Pimentel-Nunes
1   Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3   CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Francisco Mourão
3   CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Nuno Veloso
1   Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3   CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
,
Luís Pedro Afonso
4   Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
,
Manuel Jácome
4   Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
,
Luís Moreira-Dias
1   Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
,
Mário Dinis-Ribeiro
1   Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
3   CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal
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Weitere Informationen

Publikationsverlauf

submitted 26. November 2013

accepted after revision 15. Mai 2014

Publikationsdatum:
14. Juli 2014 (online)

Background and study aims: Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal.

Patients and methods: This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n = 54) or ESD (n = 141) and were followed up for a median of 3.2 years.

Results: Resection was feasible in 97 %, with en bloc and R0 resection rates of 85 % (94 % ESD vs. 61 % EMR; P = 0.001) and 81 % (91 % ESD vs. 54 % EMR; P < 0.001), respectively. The recurrence rate was 7 %, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95 % confidence interval 3.9 – 8.8). The long-term curative resection rate was 86 % after one procedure and 91 % after two procedures. Adverse events were observed in 13 % of cases: 8 % bleeding and 2 % of perforations (EMR = ESD). Surgery was performed in 7 %: 6 % after noncurative endoscopic resection and 1 % due to complications. Metachronous lesion detection rate was 1 % – 1.5 % per patient year. Cancer-specific survival rate was 100 % at follow-up.

Conclusions: For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries.

 
  • References

  • 1 Jemal A, Bray F, Center MM et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
  • 2 Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300
  • 3 Bertuccio P, Chatenoud L, Levi F et al. Recent patterns in gastric cancer: a global overview. Int J Cancer 2009; 125: 666-673
  • 4 Chen J, Bu XL, Wang QY et al. Decreasing seroprevalence of Helicobacter pylori infection during 1993–2003 in Guangzhou, southern China. Helicobacter 2007; 12: 164-169
  • 5 Ajani JA, Bentrem DJ, Besh S et al. Gastric cancer, version 2. 2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2013; 11: 531-546
  • 6 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
  • 7 Jung HY. Endoscopic resection for early gastric cancer: current status in Korea. Dig Endosc 2012; 24: 159-165
  • 8 Rosch T, Sarbia M, Schumacher B et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 2004; 36: 788-801
  • 9 Kakushima N, Hirasawa K, Morita Y et al. Terminology for training of endoscopic submucosal dissection. Dig Endosc 2012; 24: 133-135
  • 10 Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/endoscopic submucosal dissection) for early gastric cancer. Dig Endosc 2013; 25: 55-63
  • 11 Ribeiro-Mourao F, Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic submucosal dissection for gastric lesions: results of an European inquiry. Endoscopy 2010; 42: 814-819
  • 12 Deprez PH, Bergman JJ, Meisner S et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 2010; 42: 853-858
  • 13 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
  • 14 Catalano F, Trecca A, Rodella L et al. The modern treatment of early gastric cancer: our experience in an Italian cohort. Surg Endosc 2009; 23: 1581-1586
  • 15 Coda S, Trentino P, Antonellis F et al. A Western single-center experience with endoscopic submucosal dissection for early gastrointestinal cancers. Gastric Cancer 2010; 13: 258-263
  • 16 Repici A, Zullo A, Hassan C et al. Endoscopic submucosal dissection of early gastric neoplastic lesions: a western series. Eur J Gastroenterol Hepatol 2013; 25: 1261-1264
  • 17 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 2010; 42: 1037-1044
  • 18 Schumacher B, Charton JP, Nordmann T et al. Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience. Gastrointest Endosc 2012; 75: 1166-1174
  • 19 Dinis-Ribeiro M, da Costa-Pereira A, Lopes C et al. Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia. J Gastroenterol Hepatol 2007; 22: 1594-1604
  • 20 Dinis-Ribeiro M. Chromoendoscopy for early diagnosis of gastric cancer. Eur J Gastroenterol Hepatol 2006; 18: 831-838
  • 21 Dinis-Ribeiro M, da Costa-Pereira A, Lopes C et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc 2003; 57: 498-504
  • 22 Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy 2012; 44: 236-246
  • 23 Inoue H, Endo M, Takeshita K et al. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc 1992; 6: 264-265
  • 24 Inoue H, Takeshita K, Hori H et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 1993; 39: 58-62
  • 25 Dinis-Ribeiro M, Chaves P. Portuguese Society of Digestive Endoscopy: recommendations for endoscopic mucosal resection. Endoscopy 2008; 40: 622-623
  • 26 Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
  • 27 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
  • 28 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
  • 29 Folli S, Morgagni P, Roviello F et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jap J Clin Oncol 2001; 31: 495-499
  • 30 Hirasawa T, Gotoda T, Miyata S et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 2009; 12: 148-152
  • 31 Horiki N, Omata F, Uemura M et al. Risk for local recurrence of early gastric cancer treated with piecemeal endoscopic mucosal resection during a 10-year follow-up period. Surg Endosc 2012; 26: 72-78
  • 32 Ahn JY, Jung HY, Choi JY et al. Natural course of noncurative endoscopic resection of differentiated early gastric cancer. Endoscopy 2012; 44: 1114-1120
  • 33 Yokoi C, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006; 64: 212-218
  • 34 Oda I, Gotoda T, Sasako M et al. Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg 2008; 95: 1495-1500
  • 35 Cardoso R, Coburn N, Seevaratnam R et al. A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer. Gastric Cancer 2012; 15: 19-26
  • 36 Mocellin S, Marchet A, Nitti D. EUS for the staging of gastric cancer: a meta-analysis. Gastrointest Endosc 2011; 73: 1122-1134
  • 37 Choi J, Kim SG, Im JP et al. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy 2010; 42: 705-713
  • 38 Lian J, Chen S, Zhang Y et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
  • 39 Park YM, Cho E, Kang HY et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 2011; 25: 2666-2677
  • 40 Choi MK, Kim GH, Park DY et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc 2013; 27: 4250-4258
  • 41 Kato M, Nishida T, Yamamoto K et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. Gut 2013; 62: 1425-1432
  • 42 Kosaka T, Endo M, Toya Y et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc 2014; 26: 183-191
  • 43 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
  • 44 Abe N, Gotoda T, Hirasawa T et al. Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer 2012; 15: 70-75
  • 45 Isomoto H, Ohnita K, Yamaguchi N et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 2010; 22: 311-317
  • 46 Dinis-Ribeiro M, Areia M, de Vries AC et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44: 74-94
  • 47 Dinis-Ribeiro M, Areia M, de Vries AC et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Virchows Arch 2012; 460: 19-46
  • 48 Kodera Y, Sasako M, Yamamoto S et al. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 2005; 92: 1103-1109
  • 49 Kim HS, Lee DK, Baik SK et al. Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: comparison of its therapeutic efficacy with surgical resection. Yonsei Med J 2000; 41: 577-583
  • 50 Etoh T, Katai H, Fukagawa T et al. Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan. Gastrointest Endosc 2005; 62: 868-871
  • 51 Choi KS, Jung HY, Choi KD et al. EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 2011; 73: 942-948
  • 52 Chiu PW, Teoh AY, To KF et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 2012; 26: 3584-3591
  • 53 Jung H, Bae JM, Choi MG et al. Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg 2011; 98: 73-78
  • 54 Kwon HY, Hyung WJ, Lee JH et al. Outcomes of laparoscopic gastrectomy after endoscopic treatment for gastric cancer: a comparison with open gastrectomy. J Gastric Cancer 2013; 13: 51-57
  • 55 Barreiro P, Dinis-Ribeiro M. Expanded criteria for endoscopic treatment of early gastric cancer: safe in the long term if feasible in the short term!. Endoscopy 2013; 45: 689-690