Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea

Jin Seok Janga, Seok Reyol Choi*a, Waqar Qureshib, Min Chan Kimc, Su Jin Kimd, Jin Sook Jeungd, Sang Young Hana, Myung Hwan Noha, Jong Hoon Leea, Seung Wook Leea, Yang Hyun Baeka, Sung Hyun Kima & Phil Jo Choiea Department of Internal Medicine, Dong-A Medical Center, University College of Medicine, Busan, South Koreab Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USAc Department of General Surgeryd Department of Pathologye Department of Cardiac Surgery, Dong-A Medical Center, University College of Medicine, Busan, South KoreaCorrespondence: Seok Reyol Choi, MD, Dong-A Medical Center, University College of Medicine Busan, South Korea. +82 51 240 2970. +82 51 240 2087. sychoi@dau.ac.krAbstractObjective. Although endoscopic treatment for early gastric cancer (EGC) is an accepted therapy in South Korea and Japan, long-term outcomes remain unknown. We evaluated the clinical outcome of endoscopic submucosal dissection (ESD) for gastric dysplasia and EGC. Material and methods. A total of 402 patients with gastric dysplasia and EGC were treated with ESD at a single hospital from January 2004 to December 2007. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 9–49 months (median 30 months). Resectability (en bloc or piecemeal resection), curability (complete or incomplete), local recurrence, and disease-free survival rates were estimated. Results. There were 107 patients with low-grade dysplasia (LGD), 97 with high-grade dysplasia (HGD) and 198 with EGC. In EGC patients, en bloc resection was achieved in 89.7% (177/198), the complete resection rate was 87.9% (174/198), and the local recurrence rate was 5.1% (10/198). Tumor size >20 mm was significantly associated with local recurrence (odds ratio 6.45; 95% CI 1.20–20.11; p=0.001). There were significant correlations between the incidences of a piecemeal or incomplete resection and that of local recurrence (odds ratio 5.23; 95% CI 1.02–18.34; p=0.001; and odds ratio 6.99; 95% CI 1.22–21.65; p=0.002, respectively). The 3-year cancer-free survival rate was 94.9%. Conclusions. Curative treatment with successful en bloc resection can reduce the local recurrence of gastric neoplastic lesions after ESD. Clinical outcome may be excellent, although longer follow-up studies are warranted.