Z Gastroenterol 2005; 43 - 127
DOI: 10.1055/s-2005-869774

Diagnostic and therapeutic use of endoscopic mucosal resection (EMR)

T Szalóki 1, V Tóth 2, J Liebhardt 1, C Molnár 1, Z Rádics 1, M Szász 1, J Lonovics 3, L Czakó 3
  • 1Dept. of Gastroenterology, Jávorszky Hospital, Vác
  • 2Dept. of Pathology, Jávorszky Hospital, Vác
  • 31st Dept. of Medicine, University of Szeged, Szeged

Background. EMR is a widely used treatment option for gastric adenoma and early gastric cancer, but, there are no data on its use in Hungary. The aim of this study was to assess the diagnostic and therapeutic efficacy of EMR.

Patients. 39 patients (28 females, 11 males, mean age: 65.6 years) were studied between 1994 and 2004; 32 had severe concomitant diseases (liver cirrhosis or severe cardiovascular disease). Indigo carmine dye staining and electronic magnification was used in all cases, with endoscopic ultrasonography when indicated. 51 EMRs were performed. The histological results on the biopsy and resected specimens were analyzed.

Results. The morphology of the lesions was type I in 17, type IIa in 33, and type IIa-IIc in 1 case. The diagnosis at first biopsy was in situ carcinoma in 2, adenoma with no dysplasia in 17, adenoma with low-grade dysplasia in 2, adenoma with moderate-grade dysplasia in 5, adenoma with high-grade dysplasia in 5, and hyperplastic lesion in 20 cases. The histology of EMR revealed in situ carcinoma in 3, carcinoid in 1, gastrointestinal stromal tumor in 1, adenoma with no dysplasia in 12, adenoma with low-grade dysplasia in 3, adenoma with moderate-grade dysplasia in 5, adenoma with high-grade dysplasia in 5, hyperplastic lesion in 20, and no diagnosis in 1 case. However, the moderate- and high-grade dysplasia were diagnosed in different cases with the two methods. EMR was considered complete in all but 1 case. A Nd YAG laser was used in this patient with in situ carcinoma, where the resection margin was not free of cancer cells. Bleeding occurred in 3 cases; 1 required transfusion and had pneumonia postoperatively. There were no gastric cancer-related deaths during the median follow-up of 33 (1–90) months.

Conclusion. EMR, a facile and useful diagnostic and therapeutic technique, appears very safe in terms of complications even in moribund patients. Biopsy is generally unreliable to diagnose gastric adenoma. Lesions should be fully resected by EMR for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment.

Supported by ETT No. 5K 503 and BÖ No. 5/2003.