Endoscopic Mucosal Resection of Early Gastric Cancer -Indications and Limitations-

Osami Yamamoto¹⁾, Shintaro Terahata³⁾, Hitoshi Katai¹⁾, Yoichiro Hosoda¹⁾, Eikichi Shimoji²⁾, Keiichi Yoshino⁴⁾

Department of Surgery, Saitama Chuo Hospital (SCH)¹⁾, Department of Pathology of SCH²⁾, Departmet of Laboratory Medicine, National Defense Medical College³⁾ and Department of Surgery, Tokyo Dental College⁴⁾

To clarify the indications and limitations of endoscopic mucosal resection (EMR) for early gastric cancer, we reviewed 252 early cancer patients who underwent surgery and 51 cases treated by EMR. No lymph node metastasis was observed in gastric cancers localized only in the mucosa, and not accompanied with ulcer scar in the foci. We developed a new EMR technique, the so-called repeated grasping technique. Features of this technique are summarized as follows. First, we grasped the mucosa near the cancer lesion with a grasp forceps and snare. Then we released the forceps and grasped the most suitable part of the mucosa again. Next we released the snare and re-strangulated the best-suited mucosa and resected mucosa containing the cancerous lesion by electrocauterization. Using this technique, we could resected cancer foci from any part of the stomach. We could thus expand the indications for EMR more extensively. Complete resection at one time was performed in 15 cases without recurrence, whereas recurrences were recognized within 18 months in the 4 (50%) of 8 patients who had been followed up. QOL after EMR was more satisfactory compared with that after surgery. In conclusion, EMR is the best procedure for small gastric cancer, if follow-up endoscopy can be applied under the patient's informed consent.

Key words
early gastric cancer, endoscopic mucosal resection, repeated grasping resection

Reprint requests
Osami Yamamoto Department of Surgery, Saitama Chuo Hospital
4-9-3 Kitaurawa, Urawashi, 336 JAPAN

Accepted
June 14, 1993

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