Clinical Research The Value Of ESD Treatment Early Gastric Cancer And Pre-cancerous Lesions

Endoscopic Submucosal Dissection (ESD) is a new, safe and effective endoscopic treatment methods invented by Japanese endoscopic physicians in the 20th century. ESD technology developed on the basis of Endoscopic mucosal resection (EMR). Compared with the EMR, ESD can complete resection lesions, larger ulcer type lesions, provide complete materials for pathology diagnosis and prevent recurrence, etc. ESD pioneers a new way to the treatment of early gastric cancer and pre-cancerous lesions. Objective: To evaluate the clinical value of ESD treatment for early gastric cancer and pre-cancerous lesions through analyzing two aspects as following. Materials and methods: PartⅠ,47 patients underwent endoscopic submucosal dissection (ESD) for early gastric cancer and pre-cancerosis at Lanzhou University Second Hospital between November 2007 and December 2010. The preoperative pathological findings are,32 cases were early gastric cancer,8 cases were severe atypical hyperplasia, and 7 cases were moderate atypical hyperplasia. Results: the average operation time of ESD was 84.72 min, and the average diameter of peel lesions was 2.76cm. During the operations,5 cases bled heavily, stanched by snares and Titanium clips.1 case had gastric perforation with a diameter of 2～3mm blocked by Titanium clips and healed through endoscope review after medical treatment.1 case had delayed bleeding, stanched by Titanium clips on the next day after operation.1 case had postoperative perforation, transferred to surgical. Postoperative pathological confirmed 34 cases are early gastric cancer,7 cases are severe dysplasia, and 6 cases are moderate dysplasia. The accuracy rate of biopsy was 95.7%. Part 2:34 cases of early gastric cancer were followed up by regular clinic and endoscopy post endoscopic submucosal dissection. The content of follow up included digestive tract symptom and endoscopic abnormal features. The digestive tract symptom contains abdominal pain, nausea, vomiting, loss of appetite, weight loss, etc. Followed up 44 cases of early gastric cancer underwent surgical operation from Gansu WuWei Tumor Hospital and WuWei Liang Zhou District Hospital during the same period. Results: There were 7 cases of early gastric cancer followed up for 3 yeas; 12 cases for 2 yeas; 9 cases for 1 year; and 6 cases for less than 1 year in group ESD. In Follow-up period, there is 1 case found local recurrence.6 patients had digestive tract symptom over one month. There is no local recurrence in group surgical.30 patients had digestive tract symptom over one month or endoscopic abnormal manifestation.2 patients have stenosisofgastroentericstoma. Analyzing the two followed-up results with SPSS 17.0, the results suggest surgical treatment is no better than endoscope treatment on curing early gastric cancer; there have some differences on postoperative quality of life between the two groups. Conclusion: 1. ESD is a safety and effective method for early gastric cancer and pre-cancerous lesions.2. The effect of ESD treatment early gastric cancer is similar to surgical.3. The quality of long-life after ESD is better than surgical.