Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
J Gastric Cancer. 2012 Jun;12(2):99-107. doi: 10.5230/jgc.2012.12.2.99. Epub 2012 Jun 27.
Gastric mucosal neoplastic lesions should have characteristic endoscopic features for successful endoscopic submucosal dissection.
Out of the 1,010 endoscopic submucosal dissection, we enrolled 62 patients that had the procedure cancelled. Retrospectively, whether the reasons for cancelling the endoscopic submucosal dissection were consistent with the indications for an endoscopic submucosal dissection were assessed by analyzing the clinical outcomes of the patients that had the surgery.
The cases were divided into two groups; the under-diagnosed group (30 cases; unable to perform an endoscopic submucosal dissection) and the over-diagnosed group (32 cases; unnecessary to perform an endoscopic submucosal dissection), according to the second endoscopic findings, compared with the index conventional white light image. There were six cases in the under-diagnosed group with advanced gastric cancer on the second conventional white light image endoscopy, 17 cases with submucosal invasion on endoscopic ultrasonography findings, 5 cases with a size greater than 3 cm and ulcer, 1 case with diffuse infiltrative endoscopic features, and 1 case with lymph node involvement on computed tomography. A total of 25 patients underwent a gastrectomy to remove a gastric adenocarcinoma. The overall accuracy of the decision to cancel the endoscopic submucosal dissection was 40% (10/25) in the subgroup that had the surgery.
The accuracy of the decision to cancel the endoscopic submucosal dissection, after conventional white light image and endoscopic ultrasonography, was low in this study. Other diagnostic options are needed to arrive at an accurate decision on whether to perform a gastric endoscopic submucosal dissection.
胃黏膜肿瘤性病变应具有特征性的内镜特征，以便成功进行内镜黏膜下剥离术。
在 1010 例内镜黏膜下剥离术中，我们纳入了 62 例因各种原因而取消内镜黏膜下剥离术的患者。通过回顾性分析这些患者的临床结局，评估取消内镜黏膜下剥离术的原因是否与内镜黏膜下剥离术的适应证相符。
根据第二次内镜检查结果（与索引常规白光图像相比），将这些病例分为两组：诊断不足组（30 例，无法进行内镜黏膜下剥离术）和诊断过度组（32 例，无需进行内镜黏膜下剥离术）。在诊断不足组中，有 6 例在第二次常规白光内镜检查时发现进展期胃癌，17 例在内镜超声检查时发现黏膜下浸润，5 例病变直径大于 3cm 且伴有溃疡，1 例表现为弥漫浸润性内镜特征，1 例在计算机断层扫描时发现淋巴结受累。共有 25 例患者接受了胃切除术以切除胃腺癌。在接受手术的亚组中，决定取消内镜黏膜下剥离术的总体准确率为 40%（10/25）。
在本研究中，在常规白光图像和内镜超声检查后，取消内镜黏膜下剥离术的决策准确性较低。需要其他诊断选择来准确决定是否进行胃内镜黏膜下剥离术。
