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Resection Area of 15 mm as Dividing Line for Choosing Strip Biopsy or Endoscopic Submucosal Dissection for Mucosal Gastric Neoplasm

Yamaguchi, Yasuharu, MD*; Katusmi, Naoya, MD*; Aoki, Kei, MD*; Toki, Masao, MD*; Nakamura, Kenji, MD*; Abe, Nobutsugu, MD; Morozumi, Katsuro, MD*; Sugiyama, Masanori, MD; Ishida, Hitoshi, MD*; Takahashi, Shin-ichi, MD*

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 472-476
doi: 10.1097/01.mcg.0000247987.02677.b3
Alimentary Tract: Clinical Research

Background Endoscopic mucosal resection (EMR) is effective treatment for mucosal gastric neoplasm. Endoscopic submucosal dissection (ESD), a novel EMR method, has been reported to enable en bloc resection more frequently than conventional EMR methods such as strip biopsy (SB). However, ESD requires more time than SB. A small lesion can be resected en bloc and effectively treated with SB.

Goal To evaluate using a 15 mm resection area as the dividing line between SB and ESD prospectively.

Study SB was applied for resection area less than 15 mm (SB group) and ESD for 15 mm or larger resection (ESD group). We compared characteristics of lesions and outcomes of EMR between the 2 groups.

Results Ninety lesions were prospectively assigned to SB group (36 lesions) and ESD group (54 lesions). The average neoplasm size was 9.0±3.9 mm in the SB group and 19.1±11.3 mm in the ESD group (P<0.01). The average resection time was 11.7±5.8 minutes in the SB group and 128.9±102.8 minutes in the ESD group (P<0.01). The complete resection rate was 91.6% in the SB group and 83.3% in the ESD group (P=0.25). The complication rate was not significantly different between SB group and ESD group (11.1% vs. 16.7%, P=0.12). During follow-up (median 23±5 mo), 1 patient in each group, who had piecemeal resection at original EMR had recurrent neoplasm.

Conclusions Gastric mucosal neoplasms which require only small (<15 mm) resection can be treated with SB, as effectively as with ESD.

*The Third Department of Internal Medicine

The Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan

Reprints: Yasuharu Yamaguchi, MD, The Third Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan (e-mail:

Received for publication April 12, 2006; accepted September 13, 2006

© 2007 Lippincott Williams & Wilkins, Inc.