Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications

Background: Current guidelines for endoscopic management such as EMR and endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) are in evolution, with broader indication criteria. Objective: To determine the clinical outcomes of endoscopic treatment, based on absolute indication and extended indication criteria and endoscopic methods. Design: Retrospective study. Setting: Tertiary-care, academic medical center. Patients: EMR or ESD was performed on 1627 cases of EGC in 1447 patients from July 1994 to January 2009. Intervention: EMR and ESD. Main Outcome Measurements: Clinical outcomes of EGG after EMR or ESD, based on the indication criteria. Results: Although the complete resection rate was higher (95.9% vs 88.4%; P < .001), and the complication rate was lower (6.8% vs 9.8%; P = .054) in the absolute than in the extended indication group, there was no between-group difference in the local recurrence rate (0.9% vs 1.1%; P = .783) at a median follow-up period of 32 months (interquartile range 22-48 months). In the extended indication group, ESD resulted in a significantly higher complete resection rate than EMR (83.0% vs 91.1%; P = .006). Limitations: Retrospective study. Conclusion: ESD in the extended indication group showed acceptable clinical outcomes with a relatively high complete resection rate and a low local recurrence rate. (Gastrointest Endosc 2011;74:485-93.)