Case Control Study
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World J Gastroenterol. Apr 21, 2022; 28(15): 1548-1562
Published online Apr 21, 2022. doi: 10.3748/wjg.v28.i15.1548
Reevaluation of the expanded indications in undifferentiated early gastric cancer for endoscopic submucosal dissection
Jiyoung Yoon, Seung-Yeon Yoo, Young Soo Park, Kee Don Choi, Beom Su Kim, Moon-Won Yoo, In Seob Lee, Jeong Hwan Yook, Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Jiyoung Yoon, Kee Don Choi, Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, -Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Seung-Yeon Yoo, Young Soo Park, Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Beom Su Kim, Moon-Won Yoo, In Seob Lee, Jeong Hwan Yook, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Yoon J and Yoo SY equally contributed to this article; Yoon JY and Yoo SY collected and analyzed data, and drafted the manuscript; Kim BS, Yoo MW, Lee IS, Yook JH, Kim GH, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Song HJ, Lee GH and Jung HY were involved in study patient enrollment, data collection, and data analysis; Choi KD and Park YS were involved in study design, supervision, and critical revision of the study; Choi KD and Park YS equally contributed as co-corresponding authors; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center.
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board considering the retrospective design of the study.
Conflict-of-interest statement: All authors have no conflict of interest related to the study.
Data sharing statement: Data used in this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kee Don Choi, MD, PhD, Doctor, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. keedon@amc.seoul.kr
Received: December 2, 2021
Peer-review started: December 2, 2021
First decision: January 23, 2022
Revised: February 5, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 21, 2022
Processing time: 134 Days and 3.7 Hours
Core Tip

Core Tip: This was a retrospective study investigating the prevalence and risk factors of lymph node metastasis (LNM) in cases with undifferentiated early gastric cancer meeting the expanded indication for endoscopic submucosal dissection (ESD). We found that the incidence rate of LNM was 1.1% (14/1240), which was higher than expected for indicated ESD. A subsequent case-control study revealed that two histological features-histologic purity of tumors and blurring of the muscularis mucosae underneath the tumorous epithelium-are promising factors for predicting the risk of LNM. Combining these histologic features could improve the current expanded indication criteria for ESD.