Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: Comparison of its therapeutic efficacy with surgical resection

Endoscopic mucosal resection with a ligation device (EMR-L) has become impo rtant in the curative treatment of precancerous lesions and early gastric c ancers (EGCs), bur little is known of the long-term efficacy and survival r ates of EMR-L compared with surgical resection. We analyzed the therapeutic efficacy and safety of EMR-L in cases of EGC and precancerous lesions and compared the results of EMR-L with those of gastrectomy in patients with EG C over the same periods. EMR-L was performed on 20 EGCs and 54 precancerous lesions including tubular adenomas with or without severe dysplasias in 74 patients. Macroscopic type, size and location of the lesion were determine d by endoscope, and the depth of invasion in EGCs was determined by endosco pic ultrasonography and confirmed by pathologic examination of che resect e d specimens. All the EGC cases were endoscopically followed up for at least 18 months (range, 18-66 months). Patients were selected that underwent sub total gastrectomy and the survival rates were compared with those that unde rwent EMR-L. Complete resection was made in a single EMR-L treatment sessio n in 61 cases (82.4%; 91.5% were precancerous lesions and 65% were EGCs). A fter a repeat trial of EMR-L, the total rare of complete resection of preca ncerous lesions and EGCs was 92.6% and 85.0%, respectively. The survival ra te of EGCs showed that complete resection by EMR-L resulted in 2 and 5 year survival rates of 100% and 95%, which are comparable to those of surgery ( 100% and 100%). This study suggests that EMR-L is a technically simple, min imally invasive and highly sale and effective treatment modality for select ive EGCs, and offers an alternative to surgical treatment.