• Chemotherapy
• Endoscopy
• Guidelines
• Stomach neoplasms
• Surgery

• Stomach Neoplasms/therapy
• Stomach Neoplasms/diagnosis
• Humans
• Republic of Korea/epidemiology
• Evidence-Based Medicine/standards

• NCC-2112570 National Cancer Center

• Humans
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology
• Endoscopic Mucosal Resection/methods
• Endoscopy, Gastrointestinal/methods
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/pathology
• Esophageal Squamous Cell Carcinoma
• Retrospective Studies
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Treatment Outcome

• early stomach cancer
• endoscopic submucosal dissection
• gastrectomy
• wound infection

• Humans
• Endoscopic Mucosal Resection
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastric Mucosa/surgery
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

• anastomotic leakage
• gastrectomy
• operative
• stomach neoplasm
• surgical procedures

• Chemotherapy
• Endoscopy
• Guidelines
• Stomach neoplasms
• Surgery

• The Korean Gastric Cancer Association
• NCC-2112570-1 Ministry of Health and Welfare
• NCC-2112570-2 Ministry of Health and Welfare
• NCC-2112570-3 Ministry of Health and Welfare

• complications
• early gastric cancer
• endoscopic submucosal dissection
• enhanced recovery after surgery

• Endoscopy
• Gastrointestinal tumours

• Humans
• Stomach Neoplasms/pathology
• Endoscopic Mucosal Resection/methods
• Retrospective Studies
• Endoscopy
• Disease-Free Survival
• Treatment Outcome

Endoscopic forceps biopsy (EFB) lacks precision in diagnosing indeterminate tumors. When the presence of early gastric cancer (EGC) is macroscopically suspected, but biopsy pathology fails to give a diagnosis of neoplasia, it causes problems in clinical management. The purpose of this study was to discuss the outcome of gastric indeterminate tumors and the clinical factors associated with predicting EGC.

The medical records of 209 patients diagnosed with gastric indeterminate neoplasia by biopsy forceps were retrospectively studied. Initial endoscopic findings were analyzed and predictors of EGC were evaluated.

The final pathological diagnosis in 209 patients included adenocarcinoma (n = 7), high-grade intraepithelial neoplasia (n = 11), low-grade intraepithelial neoplasia (n = 21), and non-neoplastic lesion (n = 170). Multivariate analysis showed that older age (OR = 1.78; 95% CI = 1.17–2.71; p = 0.008), patients undergoing narrow band imaging (NBI) (OR = 3.40; 95% CI = 1.37–8.43; p = 0.008), and surface erosion (OR = 3.53; 95% CI = 1.41–8.84; p = 0.007) were associated with the upgraded group, and were significantly associated with risk. Univariate logistic regression analysis showed that among patients with NBI, the presence of demarcation line (DL) (OR = 24.00; 95% CI = 4.99–115.36; p < 0.0001), microvascular (MV) pattern irregularity (OR = 9.129; 95% CI = 2.36–35.34; p = 0.001), and the presence of white opaque substance (WOS) (OR = 10.77; 95% CI = 1.14–101.72; p = 0.038) were significant risk factors.

For gastric indeterminate tumors, older patient age, lesion surface with erosion, clear DL visible under NBI observation, presence of WOS, and irregular MV pattern are suggestive of the high possibility of neoplasia and need to be focused on and may benefit more from endoscopic resection treatment as opposed to simple endoscopic follow-up.

• EMR
• ESD
• early gastric cancer
• endoscopy
• gastrectomy
• gastric cancer

Gastric cancer is the third leading cause of cancer-related death. In Western countries, its lower prevalence and the absence of mass screening programmes contribute to late diagnosis and a slower implementation of minimally invasive treatments. A secondary prevention strategy through endoscopic surveillance of patients at high risk of intestinal-type gastric adenocarcinoma or by screening gastric cancer within colorectal screening programmes is cost-effective in intermediate-risk countries, though the identification of these patients remains challenging. Virtual chromoendoscopy with narrow-band imaging improves the accuracy of endoscopic diagnosis, significantly increasing the sensitivity for intestinal metaplasia while preserving specificity. Endoscopic grading of gastric intestinal metaplasia is feasible, correlates well with histological staging systems and also with gastric neoplasia risk and can be used to stratify risk. Endoscopic submucosal dissection (ESD) in the West achieves efficacy and safety outcomes similar to those reported for Eastern countries, and the long-term disease-specific survival is higher than 95%. A prospective comparative study with gastrectomy confirms its higher safety and its benefits concerning health-related quality of life. However, ESD is associated with a 5% risk of postprocedural bleeding and a 20% risk of non-curative resection. The knowledge of risk factors for adverse events and non-curative resection can improve patient selection. The risk of metachronous lesions after ESD is high (3–5% per year), and endoscopic surveillance is needed. The management of patients with non-curative resection can be optimized using risk scoring systems for lymph node metastasis.

• Endoscopy
• Gastrectomy
• Gastrointestinal
• Stomach neoplasms

• Endoscopic Mucosal Resection
• Gastric Mucosa/surgery
• Humans
• Neoplasm Recurrence, Local/epidemiology
• Retrospective Studies
• Stomach Neoplasms/surgery
• Taiwan/epidemiology
• Treatment Outcome

• Early gastric cancer
• Endoscopic submucosal dissection
• Gastrectomy
• Western countries

• Early gastric cancer
• Endoscopic submucosal dissection
• Meta-Analysis
• Surgery

• endoscopic resection
• gastrectomy
• overall survival
• recurrence
• systematic review

• gastric cancer
• lymph node metastasis
• prediction

• Early gastric cancer
• Endoscopic submucosal dissection
• Meta-analysis
• Prognosis
• Surgery

• Stomach neoplasms
• follow-up studies
• multidetector computed tomography
• recurrence
• survival

There are several surgical options for treating early gastric cancers (EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection (ESD) in treating EGC is not well established, especially when compared with resection surgery cases in a long-term follow-up scope.

To compare the safety and efficacy of the short- and long-term outcomes between ESD and resection surgery.

We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short- or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software (version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed- or random-effects models depending on heterogeneity across studies.

Fourteen studies comprising 5112 patients were eligible for analysis (2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference (WMD): -140.02 min, 95%CI: -254.23 to -34.82 min, P = 0.009], shorter hospital stay (WMD: -5.41 d, 95% CI: -5.93 to -4.89 d, P < 0.001), and lower postoperative complication rate [Odds ratio (OR) = 0.39, 95%CI: 0.28-0.55, P < 0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate (OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients. However, the long-term survival including overall survival [Hazard ratio (HR) = 0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival (HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.

In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the long-term survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.

• Early gastric cancer
• Endoscopic submucosal dissection
• Gastrectomy
• Clinical outcome
• Meta-analysis

Clinically useful molecular tools to triage gastric cancer patients are not currently available. We aimed to develop a molecular tool to predict gastric cancer risk in endoscopy-driven biopsies obtained from high-risk gastric cancer clinics in low resource settings.

We discovered and validated a DNA methylation biomarker panel in endoscopic samples obtained from 362 patients seen between 2004 and 2009 in three high-risk gastric cancer clinics in Lima, Perú, and validated it in 306 samples from the Cancer Genome Atlas project (“TCGA”). Global, epigenome wide and gene-specific DNA methylation analyses were used in a Phase I Biomarker Development Trial to identify a continuous biomarker panel that combines a Global DNA Methylation Index (GDMI) and promoter DNA methylation levels of IRF4, ELMO1, CLIP4 and MSC.

We observed an inverse association between the GDMI and histological progression to gastric cancer, when comparing gastritis patients without metaplasia (mean = 5.74, 95% CI, 4.97−6.50), gastritis patients with metaplasia (mean = 4.81, 95% CI, 3.77−5.84), and gastric cancer cases (mean = 3.38, 95% CI, 2.82−3.94), respectively (p < 0.0001). Promoter methylation of IRF4 (p < 0.0001), ELMO1 (p < 0.0001), CLIP4 (p < 0.0001), and MSC (p < 0.0001), is also associated with increasing severity from gastritis with no metaplasia to gastritis with metaplasia and gastric cancer.

Our findings suggest that IRF4, ELMO1, CLIP4 and MSC promoter methylation coupled with a GDMI>4 are useful molecular tools for gastric cancer risk stratification in endoscopic biopsies.

• ELMO1
• IRF4
• epigenome-wide DNA methylation analysis
• global DNA methylation index
• translational epigenomics

• Asia
• Early gastric cancer
• Endoscopic resection
• Meta-analysis
• Radical gastrectomy

• 5-year disease-specific survival rate
• 5-year survival rate
• Early gastric cancer
• Nationwide registry

• Endoscopic submucosal dissection
• Esophagogastric junction
• Neoplasm

Studies reporting the treatment of early colorectal cancer (ECC) by endoscopic submucosal dissection (ESD) in elderly patients are lacking in China. The aim was to evaluate the efficacy, safety and overall quality of life of elderly patients with ECC who undergoing ESD.

Three hundred and seventy-nine patients with 401 colorectal lesions entered into our study from March 2013 to March 2016 (Patients with an age 70 years old or older were divided into the elderly group and those who were less than 70-year-old entered the non-elderly group).

No significant differences were found in sex ratio, body mass index, location, endoscopic classification, pathological pattern, lesion size, mean procedure time, hospitalization days, complete excision, and en bloc resection rate between the two groups (P > 0.05). No significant differences were observed between the groups in terms of complications during and after ESD procedure (P > 0.05). There were no statistical differences between two groups in Quality of life index (QL-Index) and European Organization for Research and Treatment quality of life version 3.0 questionnaire (EORTC QLQ-C30) scores (P > 0.05).

ESD was relatively safe and effective for elderly patients with ECC, and it may be an recommended first-line treatment.

• concomitant
• egc
• esd
• gst
• outcomes
• surgery

• Academic Medical Centers
• Adult
• Aged
• Endoscopic Mucosal Resection
• Endoscopy, Digestive System
• Female
• Follow-Up Studies
• Gastrointestinal Stromal Tumors/mortality
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Length of Stay
• Male
• Middle Aged
• Neoplasm Staging
• Operative Time
• Postoperative Complications/mortality
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate
• Time Factors

• I01 BX000713 BLRD VA

• Absolute indication
• Endoscopic submucosal dissection
• Expanded indication
• Outcomes
• Undifferentiated histology

Early gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences.

A survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions.

The questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection. The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative.

Before ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.

• Endoscopic resection
• Stomach neoplasms
• Surveys and questionnaires
• Ulcer

Endoscopic submucosal dissection (ESD) is an effective treatment for gastric superficial neoplasms and curative in 80-85% of the patients. The aims of this study were to identify risk factors for non-curative resection and metachronous development, and to evaluate patient management and outcome after non-curative resection.

In this single-centre study, the outcome of consecutive patients submitted to gastric ESD was assessed during a minimum follow-up of 18 months. Univariate analysis and multivariate logistic regression were performed to identify risk factors.

ESD was performed in 194 lesions (164 patients) between 2005 and 2014. The median follow-up was 40 months. En bloc and complete resection rates were 95.3 and 93.8%, respectively. Male sex, larger tumor size, longer procedural time, and more advanced histology were associated with a non-curative resection (p < 0.05), but only carcinoma detected in biopsies before resection was identified as a significant risk factor on multivariate analysis. Metachronous lesions occurred in 18.4%, and the incidence rate was 4.7 lesions/100 person-years. Older age at diagnosis was identified as the only predictor of metachronous development in logistic regression. In the non-curative resection group, survival did not differ between patients allocated to surveillance and those submitted to gastrectomy; 75% of gastrectomy specimens showed no residual lesion.

The risk factors identified for non-curative resection help to improve patient selection and patient information. Older patients had an increased risk for the development of metachronous lesions. In patients with non-curative resections, individualized patient management and surveillance seems to be an adequate option in selected cases.

• Gastric mucosa
• Gastrointestinal endoscopy
• Risk factors
• Stomach neoplasms
• Treatment outcome

AIM: To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD).

METHODS: We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ESD.

RESULTS: Twenty-nine thousand five hundred and six tumors in 27155 patients (31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90% (95%CI: 87%-92%) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in region (P = 0.02) and sample size (P = 0.04). Endoscopic en bloc and curative resection rates were 94% (95%CI: 93%-96%) and 86% (95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7% (95%CI: 2.1%-3.3%) and 0.39% (95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9% (95%CI: 1.3-6.6) and 3.6% (95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02% (95%CI: 0.001-1.4) among those with R0 resection and 7.7% (95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75% (95%CI: 0.42%-1.3%).

CONCLUSION: Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastric tumors and warrants consideration as first line therapy when an expert operator is available.

• Endoscopic submucosal dissection
• Gastric neoplasms
• Meta-analysis

To compare the efficacy and safety of endoscopic resection (ER) and surgery for the treatment of early gastric cancer and precancerous lesions.

Databases, such as PubMed, EMBASE, Cochrane Library, and Science Citation Index, from 2000 to 2016, were searched for eligible articles. In this meta-analysis, the main outcome measurements were local recurrence, complications, metachronous lesions, hospital stay, and 5-year overall survival.

Nine trials were identified and a total of 2748 patients were included. The rate of complication was higher in the surgery group compared with the ER group (OR 0.41; 95 % CI 0.30–0.55). The rates of local recurrence and metachronous lesions were lower in the surgery group (OR 0.03; 95 % CI 0.00–0.06; OR 8.76; 95 % CI 4.17–18.41). The hospital stay was shorter in the ER group (mean difference −6.96; 95 % CI −7.94 to −5.99). The 5-year overall survival rate did not significantly differ between the two groups (OR 1.23; 95 % CI 1.03–1.47).

We provided evidence that, ER was comparable to surgery in terms of the 5-year overall survival. In addition, ER had a lower rate of complications and shorter hospital stay, but a higher rate of local recurrence and metachronous lesions for the treatment of early gastric cancer and precancerous lesions.

• Early gastric cancer
• Endoscopic resection
• Precancerous lesions
• Surgery

• Endoscopic submucosal dissection
• Gastrectomy
• Stomach neoplasms

Recent advances in the endoscopic treatment of dysplasia in Barrett’s esophagus (BE) have allowed endoscopists to provide effective and durable eradication therapies. This review summarizes the available endoscopic eradication techniques for dysplasia in patients with BE including endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, argon plasma coagulation, radiofrequency ablation and cryotherapy.

• Dysplasia
• Barrett’s esophagus
• Endoscopic therapy
• Endoscopic mucosal resection
• Radiofrequency ablation
• Endoscopy
• Photodynamic therapy

AIM: To report a systematic review, establishing the available data to an unpublished 2a strength of evidence, better handling clinical practice.

METHODS: A systematic review was performed using MEDLINE, EMBASE, Cochrane, LILACS, Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants, inclusion and exclusion criteria, interventions (mainly, mucosal resection and submucosal dissection vs surgical approach) and outcomes (adverse events, different survival rates, mortality, recurrence and complete resection rates). To ascertain the validity of eligible studies, the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software RevMan, by computing risk differences (RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ² and the Higgins method (I²). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled.

RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Three-year survival data were available for six studies (n = 1197). There were no risk differences (RD) after endoscopic and surgical treatment (RD = 0.01, 95%CI: -0.02-0.05, P = 0.51). Five-year survival data (n = 2310) showed no difference between the two groups (RD = 0.01, 95%CI: -0.01-0.03, P = 0.46). Recurrence data were analized in five studies (1331 patients) and there was no difference between the approaches (RD = 0.01, 95%CI: -0.00-0.02, P = 0.09). Adverse event data were identified in eight studies (n = 2439). A significant difference was detected (RD = -0.08, 95%CI: -0.10--0.05, P < 0.05), demonstrating better results with endoscopy. Mortality data were obtained in four studies (n = 1107). There was no difference between the groups (RD = -0.01, 95%CI: -0.02-0.00, P = 0.22).

CONCLUSION: Three-, 5-year survival, recurrence and mortality are similar for both groups. Considering complication, endoscopy is better and, analyzing complete resection data, it is worse than surgery.

• Gastric cancer
• Endoscopy
• Gastroscopy
• Gastrectomy
• Surgery
• Systematic review

• Chi-Square Distribution
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastrectomy/mortality
• Gastroscopy/adverse effects
• Gastroscopy/mortality
• Humans
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Odds Ratio
• Postoperative Complications/etiology
• Risk Assessment
• Risk Factors
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Analysis
• Time Factors
• Treatment Outcome

• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Outcome Assessment, Health Care/methods
• Outcome Assessment, Health Care/statistics & numerical data
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Proportional Hazards Models
• Reproducibility of Results
• Sensitivity and Specificity
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Survival Analysis

• Early gastric cancer
• Endoscopic mucosal resection
• Endoscopic resection
• Endoscopic submucosal dissection
• Gastrectomy
• Surgery

Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria.

A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588).

The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128–6.144] vs 3.497 [1.560–7.842], respectively) and en bloc resection rate 12.576 [7.442–21.250].

The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.

• Criteria
• Endoscopy, gastrointesti-nal
• Stomach neoplasms

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Dissection/methods
• Female
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastroscopy/methods
• Humans
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Retrospective Studies
• Risk Assessment/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Taiwan/epidemiology
• Time Factors
• Treatment Outcome