Therapeutic Decision-Making Using Endoscopic Ultrasonography in Endoscopic Treatment of Early Gastric Cancer.
- Author:
Jong Yeul LEE
1
;
Il Ju CHOI
;
Chan Gyoo KIM
;
Soo Jeong CHO
;
Myeong Cherl KOOK
;
Keun Won RYU
;
Young Woo KIM
Author Information
- Publication Type:Evaluation Studies ; Original Article ; Research Support, Non-U.S. Gov't
- Keywords: Early gastric cancer; Conventional endoscopy; Endosonography; Endoscopic submucosal dissection
- MeSH: Adult; Aged; Aged, 80 and over; Algorithms; Clinical Decision-Making/*methods; Early Detection of Cancer; Endoscopy, Gastrointestinal/*statistics & numerical data; Endosonography/*statistics & numerical data; Female; Gastric Mucosa/ultrasonography; Humans; Male; Middle Aged; *Patient Selection; Prospective Studies; Retrospective Studies; Stomach Neoplasms/surgery/*ultrasonography
- From:Gut and Liver 2016;10(1):42-50
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: We evaluated the effectiveness of an endoscopic ultrasonography (EUS)-based treatment plan compared to an endoscopy-based treatment plan in selecting candidates with early gastric cancer (EGC) for endoscopic submucosal dissection based on the prediction of invasion depth. METHODS: We reviewed 393 EGCs with differentiated histology from 380 patients who underwent EUS from July 2007 to April 2010. The effectiveness of the EUS-based and endoscopy-based plans was evaluated using a simplified hypothetical treatment algorithm. RESULTS: The numbers of endoscopically determined mucosal, indeterminate, and submucosal cancers were 253 (64.4%), 56 (14.2%), and 84 (21.4%), respectively. Overall, the appropriate treatment selection rates were 75.3% (296/393) in the endoscopy-based plan and 71.5% (281/393) in the EUS-based plan (p=0.184). For endoscopic mucosal cancers, the appropriate treatment selection rates in the endoscopy-based plan were 88.1% (223/253), while the use of an EUS-based plan significantly decreased this rate to 81.4% (206/253) (p=0.036). For endoscopic submucosal cancers, the appropriate selection rates did not differ between the endoscopy-based plan (46.4%, 39/84) and the EUS-based plan (53.6%, 45/84) (p=0.070). CONCLUSIONS: EUS did not increase the likelihood of selecting the appropriate treatment in differentiated-type EGC. Therefore, EUS may not be necessary before treating differentiated-type EGC, especially in endoscopically presumed mucosal cancers.
