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Appropriate indication for endoscopic treatment of ulcerative early gastric cancer according to depth of ulcer and morphologic change
Journal of Gastroenterology and Hepatology, 08/10/2012
Clinical Article
Lee JI et al. – Endoscopic resection with curative intent may be an acceptable option for early gastric cancer (EGC) combined with endoscopic ulcer or ulcer scar, but should be restricted to cases showing significant improvement in the size and depth of ulcer at follow–up endoscopy, and which are not accompanied with deep ulcer more than the thickness of adjacent mucosal surface and prominent surrounding mucosal fold change. In addition, histologic criteria should meet the conditions of differentiated intramucosal cancer without lymphovascular invasion.
Methods- Medical records of 183 cases of ulcerative EGC who had received endoscopic examination two or more times with a minimum interval of 1 week, and who underwent either curative surgery or endoscopic treatment were retrospectively reviewed.
- Change in ulcer morphology at follow-up endoscopy was observed in 84 cases (45.9%) with improvement and exacerbation of ulcer in 65 (35.5%) and 19 (13.8%) cases, respectively.
- The presence of type III ulcer (p<0.01), and endoscopic findings suggesting submucosal cancer invasion (tumorous bank, fusion of converging folds, hardness or decreased flexibility) (p<0.01), and incomplete ulcer healing (p=0.036) were independently associated with a higher incidence of submucosal cancer invasion.
- The incidence of lymph node metastasis was 14.1%, and undifferentiated histology and presence of lymphovascular invasion were significantly associated with a higher incidence of lymph node metastasis (p=0.018 and p=0.005, respectively).
