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⁎4722 Endoscopic mucosal resection for treatment of early gastric cancer.
*4720 ENDOSCOPIC AND HISTOLOGICAL FEATURES OF GASTRIC EROSION AFTER HELICOBACTER PYLORI ERADICATION. Kazumasa Miyake, Choitsu Sakamoto, Tetsuro Hiratsuka, Kei Shinoki, Seiji Futagami, Ken Wada, Taku Tsukui, Masafumi Kobayashi, Nippon Med Sch, Tokyo, Japan. OBJECTIVE:It has been recently reported that Helicobacter pylori(HP) eradication leads to the improvement of histological inflammation and activity. But changes of endoscopic features after eradication, espacially gastric erosion have not been agreed with views. Therefore we investigated endoscopic features and characteristics in the stomach after eradication according to the modified Sydney system. METHOD:For 35 patients (GU/13, DU/9, GDU/5, NUD/5) in whom HP was successfully eradicated, endoscopic (erythema, erosion(none, exist)) and histological features of the stomach were estimated at 2 and 6 months after eradication according to Sydney system and update Sydney system respectively. Eradication was performed with PPI, AMPC and CAM for 7~14 days. Maintenance therapy was administered only teprenone. RESULT & CONCLUSION:Histological features after eradication indicated the remarkable improvement in inflammation and activity with HP disappearance. While in endoscopic features after eradication, erythema of fundic mucosa improved correspond to histological inflammation and activity (62.9% ( 22/35 ) before treatment vs 20% ( 7/35 ) 6 months after treatment, p<0.01). However gastric erosion (flat erosion, elevated erosion, hemmorrhagic erosion) which was estimated by dividing into antrum and corpus indicated three patterns (improvement(23.8%), exacerbation(42.9%) and non-definiteness (33.3%) 6 months after treatment. 66.6 % ( 14/21 ) in exacerbation pattern included flat erosion, and especially flat erosion of antrum was observed only 3 other than exacerbation pattern. Therefore flat erosion of antrum was thought to one of special futures in exacerbation pattern. Furthermore we compared histological features between antrum flat-erosion exacerbation group and others group to investigate causes which gastric erosion exacerbates after eradication. In antrum flat-erosion exacerbation group, histological intestinal metaplasia of antrum was lesser than others group.
*4722 ENDOSCOPIC MUCOSAL RESECTION FOR TREATMENT OF EARLY GASTRIC CANCER. Hitoshi Gene Kondo, Hiroyuki Ono, Takuji Gotoda, Hajime Yamaguchi, Daizo Saito, Shigeaki Yoshida, National Cancer Ctr Hosp, Tokyo, Japan. Background: In Japan, endoscopic mucosal resection (EMR) is generally accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The results of EMR for EGC at National Cancer Center Hospital Tokyo over a 11-year period are presented. Methods: EMR was applied to patients with early cancers up to 30mm in diameter that were of well or moderately histologically differentiated type, and were superficially elevated and/or depressed (Type I, IIa and IIc) but without ulceration or definite signs of submucosal invasion. The resected specimens were carefully examined by serial sections at 2mm intervals, and if histopathology revealed submucosal invasion and/or vessel involvement, or if the resection margin was not clear, surgery was recommended. Results: Four hundred and seventy nine cancers in 445 patients were treated by EMR from 1987 to 1998, but submucosal invasion was found on subsequent pathologic examination in 74 tumors. Sixty nine percent of intramucosal cancer (278/405) was resected with a clear margin. Of 127 cancers without “complete resection’’, fourteen had an additional operation and nine were treated endoscopically, while the rest underwent intensive follow-up. Local recurrence in the stomach occurred in 17 lesions followed conservatively, in one lesion treated endoscopically and in 5 lesions with complete resection. All the tumors were diagnosed by followup endoscopy and subsequently treated by surgery. There were no gastric cancer-related deaths during a median follow-up period of 38 months (3120 months). Bleeding and perforation (5%) were two major complications in EMR, but there were no treatment-related deaths. Conclusion: In our experience, EMR allows us to perform less-invasive treatment without sacrificing the possibility of cure.
*4721 LONG-TERM FOLLOW-UP RESULTS OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER AND GASTRIC FLAT ADENOMA. Young Koog Cheon, Chang Beom Ryu, Bong Min Ko, Young Seok Kim, Su Jin Hong, Joo Young Cho, Moon Sung Lee, Chan Sup Shim, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Background: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma has been widely accepted as a useful method due to its minimal invasiveness and satisfactory post-procedure results in maintaining a good quality of life for patients. Aim: The purpose is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. Materials andMethods: We analysed, retrospectively, 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases that could be followed-up were analyzed. Follow-up endoscopy examination after EMR was performed at 1, 3, and 6 month in the first year and annually thereafter. Results: 1. The mean follow-up period was 17.7 months (1~). 2. Of the 101 lesions, there were 6 recurrences (5.9%);the mean period was 17.3 months (2~). One of 28 EGC, five of 73 gastric flatadenoma showed recurrence. Among 6 the recurrences, one was detected on the other area of primary EMR site, the other 5 lesions recurred at the primary lesions. 2. With respect to size of lesion and resection method, 16.7% of the recurred lesion were greater than 20 mm in diameter, while 3.4% were 11 to 20 mm and 4.3% were less than 10mm. The recurrence rate tended to be higher in as the size increased (p=0.06). In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), while 3.3% (2/61) of those lesions recurred in which lesions were resected en bloc(p=0.21). 3. With respect to sex and pathology of primary lesion, there was no difference in the recurrence rate. 4. With respect to location of the primarylesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05), compared to the antrum (5.5%), angle (9%) or body (3%). Conclusion: We concluded that the lesions size and location were related to recurrence after EMR, but sex, pathology, and resection method were not related. However, as the size of primary lesions increased rate of piecemeal resection also increased.
*4723 LONG-TERM OUTCOME OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER. Noriya Uedo, Hiroyasu Iishi, Masaharu Tatsuta, Hiroyuki Yano, Hiroyuki Narahara, Seishiro Mimura, Toru Otani, Shingo Ishiguro, Wakiko Ajiki, Hideaki Tsukuma, OSAKA Med Ctr FOR CANCER AND CV DISEASES, Osaka, Japan. BACKGROUND: Endoscopic mucosal resection (EMR) for intramucosal early gastric cancer (EGC) has become popular in Japan. However, its longterm results have not been clearly reported. AIM, PATIENTS AND METHODS: To elucidate the effectiveness of EMR for EGC, we studied the prognosis of 288 EGC patients who were treated by EMR with submucosal saline injection technique and compared with that of non-concurrent 46 EGC patients who took no treatment at all (NTx group). Endoscopy was repeated 1, 3, 6, 12 months or more after endoscopic resection. RESULTS: We resected 320 EGCs in 288 patients between ‘90 and ‘97. Of those who treated by EMR, 253 patients had intramucosal differentiated EGC without ulcerative change that absolutely indicates EMR (IND group) and 35 patients had submucosal, undifferentiated or ulcerative EGC (CIND group). In IND group, 143 patients failed to achieve complete resection and residual cancers were revealed in 40 patients. Endoscopic re-treatment was performed in 32 patients and operations in eight patients. In CIND group, additional operations were undergone in 16 patients and were not in 19 patients who were not candidates for surgical resection. There was no procedure-related mortality. 25 patients died of causes other than gastric cancer in IND group, whereas 7 patients died of gastric cancer and 7 died of other causes in CIND group during the mean periods of 43 months. The cumulative 5-years’ survival rate was significantly higher in IND group than that of in CIND group and NTx group, (85%, 55% and 53%, respectively). CONCLUSION: EMR is effective treatment for intramucosal differentiated EGC without ulcerative change but not for submucosal, undifferentiated or ulcerative EGC.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB213
*4722 ENDOSCOPIC MUCOSAL RESECTION FOR TREATMENT OF EARLY GASTRIC CANCER. Hitoshi Gene Kondo, Hiroyuki Ono, Takuji Gotoda, Hajime Yamaguchi, Daizo Saito, Shigeaki Yoshida, National Cancer Ctr Hosp, Tokyo, Japan. Background: In Japan, endoscopic mucosal resection (EMR) is generally accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The results of EMR for EGC at National Cancer Center Hospital Tokyo over a 11-year period are presented. Methods: EMR was applied to patients with early cancers up to 30mm in diameter that were of well or moderately histologically differentiated type, and were superficially elevated and/or depressed (Type I, IIa and IIc) but without ulceration or definite signs of submucosal invasion. The resected specimens were carefully examined by serial sections at 2mm intervals, and if histopathology revealed submucosal invasion and/or vessel involvement, or if the resection margin was not clear, surgery was recommended. Results: Four hundred and seventy nine cancers in 445 patients were treated by EMR from 1987 to 1998, but submucosal invasion was found on subsequent pathologic examination in 74 tumors. Sixty nine percent of intramucosal cancer (278/405) was resected with a clear margin. Of 127 cancers without “complete resection’’, fourteen had an additional operation and nine were treated endoscopically, while the rest underwent intensive follow-up. Local recurrence in the stomach occurred in 17 lesions followed conservatively, in one lesion treated endoscopically and in 5 lesions with complete resection. All the tumors were diagnosed by followup endoscopy and subsequently treated by surgery. There were no gastric cancer-related deaths during a median follow-up period of 38 months (3120 months). Bleeding and perforation (5%) were two major complications in EMR, but there were no treatment-related deaths. Conclusion: In our experience, EMR allows us to perform less-invasive treatment without sacrificing the possibility of cure.
*4721 LONG-TERM FOLLOW-UP RESULTS OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER AND GASTRIC FLAT ADENOMA. Young Koog Cheon, Chang Beom Ryu, Bong Min Ko, Young Seok Kim, Su Jin Hong, Joo Young Cho, Moon Sung Lee, Chan Sup Shim, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Background: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma has been widely accepted as a useful method due to its minimal invasiveness and satisfactory post-procedure results in maintaining a good quality of life for patients. Aim: The purpose is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. Materials andMethods: We analysed, retrospectively, 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases that could be followed-up were analyzed. Follow-up endoscopy examination after EMR was performed at 1, 3, and 6 month in the first year and annually thereafter. Results: 1. The mean follow-up period was 17.7 months (1~). 2. Of the 101 lesions, there were 6 recurrences (5.9%);the mean period was 17.3 months (2~). One of 28 EGC, five of 73 gastric flatadenoma showed recurrence. Among 6 the recurrences, one was detected on the other area of primary EMR site, the other 5 lesions recurred at the primary lesions. 2. With respect to size of lesion and resection method, 16.7% of the recurred lesion were greater than 20 mm in diameter, while 3.4% were 11 to 20 mm and 4.3% were less than 10mm. The recurrence rate tended to be higher in as the size increased (p=0.06). In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), while 3.3% (2/61) of those lesions recurred in which lesions were resected en bloc(p=0.21). 3. With respect to sex and pathology of primary lesion, there was no difference in the recurrence rate. 4. With respect to location of the primarylesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05), compared to the antrum (5.5%), angle (9%) or body (3%). Conclusion: We concluded that the lesions size and location were related to recurrence after EMR, but sex, pathology, and resection method were not related. However, as the size of primary lesions increased rate of piecemeal resection also increased.
*4723 LONG-TERM OUTCOME OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER. Noriya Uedo, Hiroyasu Iishi, Masaharu Tatsuta, Hiroyuki Yano, Hiroyuki Narahara, Seishiro Mimura, Toru Otani, Shingo Ishiguro, Wakiko Ajiki, Hideaki Tsukuma, OSAKA Med Ctr FOR CANCER AND CV DISEASES, Osaka, Japan. BACKGROUND: Endoscopic mucosal resection (EMR) for intramucosal early gastric cancer (EGC) has become popular in Japan. However, its longterm results have not been clearly reported. AIM, PATIENTS AND METHODS: To elucidate the effectiveness of EMR for EGC, we studied the prognosis of 288 EGC patients who were treated by EMR with submucosal saline injection technique and compared with that of non-concurrent 46 EGC patients who took no treatment at all (NTx group). Endoscopy was repeated 1, 3, 6, 12 months or more after endoscopic resection. RESULTS: We resected 320 EGCs in 288 patients between ‘90 and ‘97. Of those who treated by EMR, 253 patients had intramucosal differentiated EGC without ulcerative change that absolutely indicates EMR (IND group) and 35 patients had submucosal, undifferentiated or ulcerative EGC (CIND group). In IND group, 143 patients failed to achieve complete resection and residual cancers were revealed in 40 patients. Endoscopic re-treatment was performed in 32 patients and operations in eight patients. In CIND group, additional operations were undergone in 16 patients and were not in 19 patients who were not candidates for surgical resection. There was no procedure-related mortality. 25 patients died of causes other than gastric cancer in IND group, whereas 7 patients died of gastric cancer and 7 died of other causes in CIND group during the mean periods of 43 months. The cumulative 5-years’ survival rate was significantly higher in IND group than that of in CIND group and NTx group, (85%, 55% and 53%, respectively). CONCLUSION: EMR is effective treatment for intramucosal differentiated EGC without ulcerative change but not for submucosal, undifferentiated or ulcerative EGC.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB213