Resection area of 15 mm as dividing line for choosing strip biopsy or endoscopic submucosal dissection for mucosal gastric neoplasm

Background: Endoscopic mucosal resection (EMR) is effective treatment for mucosal gastric neoplasm. Endoscopic submucosal dissection (ESD), a novel EMR method, has been reported to enable en bloc resection more frequently than conventional EMR methods such as strip biopsy (SB). However, ESD requires more time than SB. A small lesion can be resected en bloc and effectively treated with SB. Goal: To evaluate using a 15mm resection area as the dividing line between SB and ESD prospectively. Study: SB was applied for resection area less than 15mm (SB group) and ESD for 15 mm or larger resection (ESD group). We compared characteristics of lesions and outcomes of EMR between the 2 groups. Results: Ninety lesions were prospectively assigned to SB group (36 lesions) and ESD group (54 lesions). The average neoplasm size was 9.0 +/- 3.9 mm in the SB group and 19.1 +/- 11.3 mm in the ESD group (P < 0.01). The average resection time was 11.7 +/- 1 5.8 minutes in the S13 group and 128.9 +/- 102.8 minutes in the ESD group (P < 0.01). The complete resection rate was 91.6% in the S13 group and 83.3% in the ESD group (P = 0.25). The complication rate was not significantly different between SB group and ESD group (11. 1% vs. 16.7 %, P = 0. 12). During follow-up (median 23 5 mo), I patient in each group, who had piecemeal resection at original EMR had recurrent neoplasm. Conclusions: Gastric mucosal neoplasms which require only small ( < 15 mm) resection can be treated with SB, as effectively as with ESD.