Original ArticlesSuccess rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate☆
Section snippets
Patients and methods
EMRSH was performed for 70 early stage neoplastic lesions of the stomach between June 1998 and April 2001. Use of EMRSH was approved by the ethical committee of our medical school, and written informed consent was obtained from all patients. The mean age of the 70 patients (55 men, 15 women) was 70.1 years (range 48-85 years); follow-up ranged from 3 to 38 months (median 14 months). Indications for curative EMR were (1) well or moderately differentiated adenocarcinoma or adenoma, (2) absence of
Results
Seventy early stage neoplastic lesions of the stomach in 66 patients were treated by EMRSH during the study period of 35 months. Five lesions in 5 patients (4 with ulceration scars and 1 poorly differentiated type with submucosal invasion) were treated without curative intent. The early stage lesions consisted of 56 adenocarcinomas and 14 adenomas. Mean size of the lesions was 19.9 mm (5-60 mm); the mean size of the resection specimens was 30.0 mm (15-73 mm). The en bloc resection rate and
Discussion
EMR is widely accepted as a standard treatment for early stage neoplastic lesions of GI tract including intramucosal carcinoma and benign tumors with malignant potential.2 Although EMR is beneficial because it is much less invasive than open surgery, the indication for this technique should be carefully evaluated because some lesions are only curable with open surgery. EMR with curative intent is indicated for lesions with minimum risk of lymph node involvement. Strict inclusion criteria for
Disclosure
The primary investigator holds a patent entitled “Method of endoscopic mucosal resection using mucopolysacharide and local injection preparation” filed on May 16, 2000 (United States Patent number 09,570,515).
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Reprint requests: Hironori Yamamoto, MD, Department of Gastroenterology, Jichi Medical School, Yakushiji, Minamikawachi, Tochigi, Japan 329-0498.