Indication of ESD for the early gastric cancer – Analysis from the surgical operation case – *
In recent years, endoscopic submucosal dissection (ESD) has become a newly established endoscopic technique for the treatment of gastrointestinal cancers. Some mucosal lesions larger than 20 mm in size, which are not an indication of conventional endoscopic mucosal resection (EMR), are able to be treated by ESD. Therefore, the preoperative diagnosis － especially the accuracy in diagnosing the depth of submucosal invasion － is now critically important. We selected patients who had received surgical operations for gastric cancer which used ESD, and investigated the preoperative diagnostic methods. In 15 years, 47 patients had surgical operations for cancer lesions where endoscopic treatment could be applied. Preoperative assessments of tumor invasion depth were incorrect in 29 patients examined by endoscopy or endoscopic ultrasonography, and in one patient by upper GI series. In 10 patients, the histological diagnosis of the biopsy samples were wrong, and differentiated carcinomas were misdiagnosed as undifferentiated carcinomas. (Accepted on August 17, 2010)
