Abstract:
BACKGROUND:Endoscopic submucosal dissection (ESD) criteria are histologically categorized by early gastric cancer (EGC) with differentiated- and undifferentiated-type histology. However, EGC is histologically heterogenous and there have been no separate criteria for EGC with mixed-type histology [EGC-MH; differentiated-type predominant EGC mixed with an undifferentiated component (EGC-MD) or undifferentiated-type predominant EGC mixed with a differentiated component (EGC-MU)]. Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described. AIM:This study aimed to evaluate the feasibility of ESD for EGC-MH. METHODS:We searched core databases for specific inclusion factors: patients with EGC-MH, intervention of ESD, and at least one of the following outcomes: rate of en bloc, complete, curative resection, recurrence, procedure-related adverse event, lymphovascular invasion (LVI), or lymph node metastasis (LNM) that enabled evaluation of feasibility of ESD. RESULTS:A total of eight (systematic review) and four studies (meta-analysis) were included. There was no robustness in age, location, or morphology of EGC-MH. Moderately differentiated adenocarcinoma was frequent in pre-ESD biopsy. EGC-MH showed larger size, deeper invasion, and higher rates of LVI/LNM than pure-type EGC. Total en bloc, complete resection, and curative resection rates were 94.6% (95% confidence interval 86.6-97.9%), 77.8% (57.9-89.9%), and 55.1% (50.4-59.6%), respectively. There was no LNM or extra-gastric recurrence after ESD if the EGC-MD met the curative resection criteria. However, the EGC-MD itself was a risk factor for non-curative resection. (Margin positivity was the most common reason.) CONCLUSIONS: Although ESD seems to be technically feasible, inaccurate prediction of lateral or vertical margin leads to lower curative resection rate. Application of more strict indication is needed for EGC-MH.
journal_name
Dig Dis Scijournal_title
Digestive diseases and sciencesauthors
Bang CS,Yang YJ,Lee JJ,Baik GHdoi
10.1007/s10620-019-05761-wsubject
Has Abstractpub_date
2020-01-01 00:00:00pages
276-291issue
1eissn
0163-2116issn
1573-2568pii
10.1007/s10620-019-05761-wjournal_volume
65pub_type
杂志文章,meta分析abstract::Five cases of granular cell tumor of the esophagus are reported. In four cases, the tumor was an asymptomatic, incidental finding. In one case, a larger granular cell tumor presented with dysphagia and required local surgical excision. Long-term follow-up in three cases revealed no evidence of tumor progression. Esoph...
journal_title:Digestive diseases and sciences
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doi:10.1007/BF01536687
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abstract::Although viral hepatitis infection is known to be associated with aplastic anemia, a causal link between viral hepatitis and aplastic anemia has not been convincingly demonstrated. A case of hepatitis B-associated severe aplastic anemia is described which only partially responded to conventional immunosuppressive trea...
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journal_title:Digestive diseases and sciences
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journal_title:Digestive diseases and sciences
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journal_title:Digestive diseases and sciences
pub_type: 杂志文章
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更新日期:1981-02-01 00:00:00
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