Endoscopic submucosal dissection in early gastric cancer inelderly patients and comorbid conditions

• 作者: Masahiko Tsujii Masashi Yamamoto Motohiko Kato Shiro Hayashi Teppei Yoshioka Tetsuo Takehara. Tomofumi Akasaka Tomoki Michida Toshiyuki Yoshio Tsutomu Nishida Yoshito Hayashi
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic SUBMUCOSAL DISSECTION Gastriccancer ELDERLY PERSON ANTITHROMBOTIC agents LIVERCIRRHOSIS Chronic kidney disease
• 年，卷（期）: 2015,（5）
• 页码范围: 524-531
• 页数: 8页
• 分类号: R

摘要

The prognosis of early gastric cancer （EGC） is goodif there is no concomitant lymph node metastasis.Therefore, the early detection of EGC is important toimprove the prognosis of patients with gastric cancer.In Japan, 40% to 50% of all gastric cancers areEGC, and endoscopic submucosal dissection （ESD） iswidely accepted as a local treatment for these lesions,particularly for large lesions that at one time were anindication for gastrectomy because of the difficultyof en-bloc resection. Consequently, this procedurecan preserve the entire stomach and the patient＇spostoperative quality of life. ESD has become a generaltechnique with improved procedures and devices, andhas become the preferred treatment for EGC ratherthan gastrectomy. Therefore, ESD may demonstratemany advantages in patients who have several comorbidities,particularly elderly population, patients takingantithrombotic agents, or patients with chronic kidneydisease, or liver cirrhosis. However, it is not yet clearwhether patients with both EGC and comorbidities arefeasible candidates for ESD and whether they wouldconsequently be able to achieve a survival benefitafter ESD. In this review, we discuss the clinical problemsof ESD in patients with EGC and those comorbidconditions.