Background: Endoscopic submucosal dissection (ESD) criteria are histologically categorized by early gastric cancer (EGC) with differentiated- and undifferentiated-type histology. However, EGC is histologically heterogenous and there have been no separate criteria for EGC with mixed-type histology [EGC-MH; differentiated-type predominant EGC mixed with an undifferentiated component (EGC-MD) or undifferentiated-type predominant EGC mixed with a differentiated component (EGC-MU)]. Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described.
Aim: This study aimed to evaluate the feasibility of ESD for EGC-MH.
Methods: We searched core databases for specific inclusion factors: patients with EGC-MH, intervention of ESD, and at least one of the following outcomes: rate of en bloc, complete, curative resection, recurrence, procedure-related adverse event, lymphovascular invasion (LVI), or lymph node metastasis (LNM) that enabled evaluation of feasibility of ESD.
Results: A total of eight (systematic review) and four studies (meta-analysis) were included. There was no robustness in age, location, or morphology of EGC-MH. Moderately differentiated adenocarcinoma was frequent in pre-ESD biopsy. EGC-MH showed larger size, deeper invasion, and higher rates of LVI/LNM than pure-type EGC. Total en bloc, complete resection, and curative resection rates were 94.6% (95% confidence interval 86.6-97.9%), 77.8% (57.9-89.9%), and 55.1% (50.4-59.6%), respectively. There was no LNM or extra-gastric recurrence after ESD if the EGC-MD met the curative resection criteria. However, the EGC-MD itself was a risk factor for non-curative resection. (Margin positivity was the most common reason.) CONCLUSIONS: Although ESD seems to be technically feasible, inaccurate prediction of lateral or vertical margin leads to lower curative resection rate. Application of more strict indication is needed for EGC-MH.
Keywords: Early gastric cancer; Endoscopic submucosal dissection; Histologic heterogeneity; Mixed-type histology.
Endoscopic Submucosal Dissection of Early Gastric Cancer With Mixed-Type Histology: Protocol for a Systematic Review and Meta-AnalysisCS Bang et al. Medicine (Baltimore) 97 (51), e13838. PMID 30572552.This study will provide evidence of ESD for EGC-MH.
Outcomes of Endoscopic Submucosal Dissection for Differentiated-Type Early Gastric Cancer With Histological HeterogeneityBH Min et al. Gastric Cancer 18 (3), 618-26. PMID 24801199.Long-term outcomes after ESD were favorable for MUC-EGCs meeting the curative ER criteria for tumors of absolute or expanded indications. Therefore, ESD may be used as a …
Endoscopic Submucosal Dissection for Papillary Adenocarcinoma of the Stomach: Is It Really Safe?HJ Lee et al. Gastric Cancer 20 (6), 978-986. PMID 28271420.The use of ESD should be more carefully applied in patients with EGC-P meeting the ESD indication criteria, especially the expanded indication criteria, after pretreatmen …
Endoscopic Submucosal Dissection of Papillary Adenocarcinoma of Stomach; Protocol for a Systematic Review and Meta-AnalysisCS Bang et al. Medicine (Baltimore) 97 (52), e13905. PMID 30593208. - ReviewThis study will provide evidence of ESD for EGC with PAC.
Endoscopic Submucosal Dissection for Early Gastric Cancers With Uncommon HistologyGH Kim. Clin Endosc 49 (5), 434-437. PMID 27744663. - ReviewEndoscopic submucosal dissection (ESD) enables en bloc curative resection of early gastric cancers (EGCs) with a negligible risk of lymph node metastasis (LNM). Al …
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Early Gastric Cancer With Mixed-Type Histology: A Mixed Bag or Pure Evil?MO Othman. Dig Dis Sci 65 (1), 11-12. PMID 31732906.