Endoscopic submucosal dissection for early gastric cancers and large flat adenomas

Background and study aim: Endoscopic submucosal dissection (ESD) is a new diagnostic and treatment technique for early gastric cancer (EGC). The present study aims to identify the technical feasibility, operation time, and complications associated with ESD. Methods: We reviewed the patients who underwent ESD for EGCs at Maebashi Red Cross Hospital. Results: There were 160 patients with 171 EGCs treated by ESD. The mean age was 71.4 +/- 8.9 years (median 72). The rate for one-piece resection with tumor-free margins was 94.2% (161/171), and was 93.2% (82/88) for large lesions (> 20 mm) and 92.1% (35/38) for ulcerative lesions. The median operation time was 80 min (range 10-600 min). Evidence of immediate bleeding was found in 2.9% (5/171), delayed bleeding was seen in 7.6% (13/171), and perforation was observed in 3.5% (6/171) of the lesions. All patients with complications, including perforation, were successfully treated endoscopically. There were no local or distant metastases in the lesions which met our indication criteria for ESD. Conclusion: The present study shows the technical feasibility of ESD, which provides the capability of one-piece resection even in large and ulcerative lesions.