Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: Comparison of its therapeutic efficacy with surgical resection
Hs. Kim 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, 41(5), 2000, pp. 577-583
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.