Nishida Tsutomu, Kato Motohiko, Yoshio Toshiyuki, Akasaka Tomofumi, Yoshioka Teppei, Michida Tomoki, Yamamoto Masashi, Hayashi Shiro, Hayashi Yoshito, Tsujii Masahiko, Takehara Tetsuo
Tsutomu Nishida, Masashi Yamamoto, Shiro Hayashi, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
World J Gastrointest Endosc. 2015 May 16;7(5):524-31. doi: 10.4253/wjge.v7.i5.524.
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.
如果早期胃癌（EGC）没有合并淋巴结转移，其预后良好。因此，早期发现EGC对于改善胃癌患者的预后很重要。在日本，所有胃癌中40%至50%为EGC，内镜下黏膜下剥离术（ESD）作为这些病变的局部治疗方法被广泛接受，特别是对于那些因整块切除困难一度需要行胃切除术的大病变。因此，该手术可以保留整个胃以及患者的术后生活质量。随着手术方法和器械的改进，ESD已成为一种常规技术，并已成为EGC而非胃切除术的首选治疗方法。因此，ESD在患有多种合并症的患者中可能显示出许多优势，特别是老年人群、服用抗血栓药物的患者、慢性肾病患者或肝硬化患者。然而，EGC合并合并症的患者是否适合ESD以及他们在ESD后是否能获得生存益处尚不清楚。在本综述中，我们讨论了EGC合并合并症患者ESD的临床问题。
