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World J Gastrointest Endosc. May 16, 2015; 7(5): 524-531
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.524
Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions
Tsutomu Nishida, Motohiko Kato, Toshiyuki Yoshio, Tomofumi Akasaka, Teppei Yoshioka, Tomoki Michida, Masashi Yamamoto, Shiro Hayashi, Yoshito Hayashi, Masahiko Tsujii, Tetsuo Takehara
Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
Motohiko Kato, Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo 173-8605, Japan
Toshiyuki Yoshio, Division of Gastroenterology, Cancer Institute Hospital, Tokyo 173-8605, Japan
Tomofumi Akasaka, Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 560-8565, Japan
Teppei Yoshioka, Yoshito Hayashi, Masahiko Tsujii, Tetsuo Takehara, Department of Gastroenterology and Hepatology, Osaka University of Graduate School of Medicine, Osaka 560-8565, Japan
Tomoki Michida, Department of Gastroenterology, Teikyo University Medical Center, Tokyo 173-8605, Japan
Author contributions: All the authors equally contributed to this work.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsutomu Nishida, MD, Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka 560-8565, Japan. tnishida.gastro@gmail.com
Telephone: +81-6-68430101 Fax: +81-6-68583531
Received: September 16, 2014
Peer-review started: September 18, 2014
First decision: September 28, 2014
Revised: October 17, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 16, 2015
Processing time: 243 Days and 13.9 Hours
Abstract

The prognosis of early gastric cancer (EGC) is good if there is no concomitant lymph node metastasis. Therefore, the early detection of EGC is important to improve the prognosis of patients with gastric cancer. In Japan, 40% to 50% of all gastric cancers are EGC, and endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for these lesions, particularly for large lesions that at one time were an indication for gastrectomy because of the difficulty of en-bloc resection. Consequently, this procedure can preserve the entire stomach and the patient’s postoperative quality of life. ESD has become a general technique with improved procedures and devices, and has become the preferred treatment for EGC rather than gastrectomy. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities, particularly elderly population, patients taking antithrombotic agents, or patients with chronic kidney disease, or liver cirrhosis. However, it is not yet clear whether patients with both EGC and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in patients with EGC and those comorbid conditions.

Keywords: Endoscopic submucosal dissection; Gastric cancer; Elderly person; Antithrombotic agents; Liver cirrhosis; Chronic kidney disease

Core tip: Endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for gastric cancer, particularly for early gastric cancer. Consequently, this procedure can preserve the entire stomach and the patient’s postoperative quality of life. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities. However, it is not yet clear whether patients with both early gastric cancer (EGC) and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in EGC in elderly patients and patients with comorbid conditions.