Subscribe to RSS
DOI: 10.1055/s-2002-35851
Is Endoscopic Ultrasonography Indispensable in Assessing the Appropriateness of Endoscopic Resection for Gastric Cancer?
Publication History
Submitted: 14 December 2001
Accepted after Revision: 25 July 2002
Publication Date:
02 December 2002 (online)

Background and Study Aims: Endoscopic resection is increasingly being used in the treatment of early gastric
cancer. The aim of the present study was to investigate the accuracy of pretherapeutic
staging techniques for assessing the appropriateness of endoscopic resection.
Patients and Methods: Both endoscopy and endosonography were carried out at our institution in the treatment
of 234 early gastric cancers, with histological confirmation of malignancy following
surgical resection (137 lesions) or endoscopic resection (97 lesions). The accuracy
in detecting intramucosal cancer with each of the diagnostic procedures was assessed.
Results: The accuracy rates for detecting intramucosal cancer using endoscopy and endosonography
were calculated as 84 % (197 of 234) and 78 % (182 of 234), respectively. The accuracy
tended to be lower in lesions located in the upper third of the stomach, in those
measuring 2 cm or more in diameter, and in those with an undifferentiated histology
with ulcer fibrosis. However, there were no significant differences in the accuracy
rates between endoscopy and endosonography. Precise staging was achieved by endoscopy
alone in 103 of 109 differentiated adenocarcinomas without ulcer fibrosis, where the
lesions measured less than 2 cm in diameter.
Conclusions: Endoscopic resection is indicated in intramucosal gastric cancer lesions showing
differentiated histology, no ulcer fibrosis and a diameter of less than 2 cm. EUS
may additionally be used for further evaluation in these patients.
References
- 1 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer. Endoscopy. 1993; 25 445-450
- 2 Takekoshi T, Baba Y, Ota H. et al . Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy. 1994; 26 352-358
- 3 Yasuda K. Endoscopic ultrasonic probes and mucosectomy for early gastric carcinoma. Gastrointest Endosc. 1996; 43 S29-S31
- 4 Akahoshi K, Chijiiwa Y, Hamada S. et al . Endoscopic ultrasonography: a promising method for assessing the prospects of endoscopic mucosal resection in early gastric cancer. Endoscopy. 1997; 29 614-619
- 5 Ohashi S, Segawa K, Okamura S. et al . The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer. Gut. 1999; 45 599-604
- 6 Korenaga D, Haraguchi M, Tsujitani S. et al . Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients. Br J Surg. 1986; 73 431-433
- 7 Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg. 1992; 79 241-244
- 8 Yamao T, Shirao K, Ono H. et al . Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996; 77 602-606
- 9 Nakamura K, Morisaki T, Sugitani A. et al . An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer. 1999; 85 1500-1505
- 10 Akahoshi K, Misawa T, Fujishima H. et al . Preoperative evaluation of gastric cancer by endoscopic ultrasound. Gut. 1991; 32 479-482
- 11 Akahoshi K, Misawa T, Fujishima H. et al . Regional lymph node metastasis in gastric cancer: evaluation with endoscopic US. Radiology. 1992; 182 559-564
- 12 Dittler H J, Siewert J R. Role of endoscopic ultrasonography in gastric cancer. Endoscopy. 1993; 25 162-166
- 13 Yanai H, Matsumoto Y, Harada T. et al . Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study. Gastrointest Endosc. 1997; 46 212-216
- 14 Yanai H, Noguchi T, Mizumachi S. et al . A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut. 1999; 44 361-365
- 15 Japanese Research Society for Gastric Cancer .Japanese classification of gastric cancer. Tokyo: Kanehara; 1999
- 16 Sano T, Okuyama Y, Kobori O. et al . Early gastric cancer: endoscopic diagnosis of depth of invasion. Dig Dis Sci. 1990; 35 1340-1344
- 17 Hizawa K, Suekane H, Kawasaki M. et al . Diffuse cystic malformation and neoplasia associated cystic formation in the stomach: endosonographic features and diagnosis of tumor depth. J Clin Gastroenterol. 1997; 25 634-639
- 18 Schlemper R J, Itabashi M, Kato Y. et al . Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet. 1997; 349 1725-1729
K. Hizawa, M.D.
Dept. of Medicine and Clinical Science · Graduate School of Medical Sciences · Kyushu
University
Maidashi 3-1-1, Higashi-ku · Fukuoka 812-8582 · Japan
Fax: + 81-92-642-5273 ·
Email: hizawa@intmed2.med.kyushu-u.ac.jp