IT-ESD is Useful Technique for the Elderly Patients with Gastric Cancer

Background: Minimally invasive treatments, such as endoscopic mucosal resection (EMR), are now performed as usual clinical practice in Japan. Moreover, the introduction of various new devices, such as the insulation-tipped electrosurgical knife (IT-Knife), has expanded the indication of EMR for the treatment of early-stage gastric carcinoma, and it is called as endoscopic submucosal dissection using an IT-knife (IT-ESD). IT-ESD makes EMR possible to remove more wide lesion and en bloc resection. However, the safety of this strategy has not validated completely, particularly for elderly patients. In order to assess the availability and safety, especially for the elderly patients with gastric carcinoma, we evaluated efficacy of our expanded criteria compare to the standard criteria, and analyzed our results of IT-ESD retrospectively. Materials & Methods: All patients were undergoing for mucosal gastric carcinoma treated with IT-ESD in our expanded criteria. Our expanded criteria is 1. Mucosal invasive lesion, 2. Adenoma with severe atypia and differentiated carcinoma, 3. No ulceration, 4. Without limitation of tumor size. We retrospectively reviewed the records of 184 patients admitted to St. Marianna University School of Medicine Hospital with our criteria between April 2002 and November 2005. We analyzed our data in several factors, including resection rate, en bloc resection rate, recurrent rage, age, and background characteristics of the patients. We also assessed our expanded criteria compared to the standard one. Results: The number of 154 cases out of 184 (83.7%) were completely removed and 164 cases (87.0%) were en bloc resected with IT-ESD. Two cases were diagnosed to be recurrence by follow up endoscopic biopsy. One case was retried by IT-ESD and another was treated by laparoscopic gastrectomy. Complications, such as post operative bleeding and minimal perforation, occurred in 6%. IT-ESD could remove large lesions (over 20 mm) compare to the traditional EMR apparently. This cohort contained 119 cases (64.7%) of elderly (over 65 years old). There was no significant difference in resection rate and complication between elderly and others. Conclusion: IT-ESD might be safe and useful for treatment of larger tumor than the standard criteria. Moreover, IT-ESD may be useful technique for the elderly patients with gastric cancer.