Gut Liver.  2016 Jan;10(1):42-50. 10.5009/gnl14401.

Therapeutic Decision-Making Using Endoscopic Ultrasonography in Endoscopic Treatment of Early Gastric Cancer

• Lee JY
• Choi IJ
• Kim CG
• Cho SJ
• Kook MC
• Ryu KW
• Kim YW

• KMID: 2382342
• DOI: http://doi.org/10.5009/gnl14401

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.

Keyword

Early gastric cancer; Conventional endoscopy; Endosonography; Endoscopic submucosal dissection

MeSH Terms

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