Endoscopic submucosal dissection (ESD) has recently been established as a standard treatment in Japan for early gastric neoplasms, and this procedure is being used increasingly worldwide. However, the problems are the advanced techniques required and the high frequency of procedure-related complications. The aim of this study was to investigate the efficacy of ESD for early gastric neoplasms.Methods
This study investigated 1123 lesions (967 cases) in early gastric neoplasms treated by ESD at three institutions. We investigated patient characteristics; size, type, and location of lesions; en bloc and curative resection rate; frequency of residual disease or recurrence; procedure time; and procedure-related complications.Results
The median age was 72 years, 678 males and 289 females. The mean follow-up period was 788 days. The lesions were located in the upper area of the stomach in 241 (21%), the middle area in 449 (40%), the lower area in 427 (38%) lesions. The mean size of lesions was 18.5 mm, and the mean size of resected specimens was 35.2 mm. Among underlying diseases, hypertension was present in 456 (41%), diabetes mellitus in 155 (14%), and 183 (16%) cases were treated with anti-coagulation agents. The en bloc resection rate was 94%, and the curative resection rate was 84%. The rate of residual disease and recurrence was only 1.1%. The death rate was 3.2 %; however, the reasons were attributed to the other diseases. The mean procedure time was 98 min. Regarding procedure-related complications, perforations occurred in 27 (2.4%), and delayed bleeding was observed in 56 (5.0%).Conclusions
This study demonstrated that ESD for early gastric neoplasms is an excellent procedure, because the en bloc and curative resection rates are very high and residual disease or recurrence is rare. However, we also clarified that the problems associated with this procedure are the long procedure time and relatively high frequencies of procedure-related complications.