Stomach and Duodenum EGC

The EMR is now an established treatment for patients with small EGC. The outcome of 479 ECGs treated by EMR has been reported. Among patients with intramucosal cancers, 5.7% had recurrence. In the group of 127 patients with incomplete resection, 24 had surgery and 9 had further endo-scopic therapy. Among patients with unfavorable prognosis, 18% had a local recurrence, after a median follow-up of 4 months. The perforation rate was 5%. Tanabe and colleagues (2002) performed EMR in 106 patients with EGC."En bloc" resection was performed in patients with a lesion < 10 mm in diameter, and piecemeal in lesions ranging between 10 to 20 mm. One (1.5%) perforation occurred in the "en-bloc" group and was managed endoscopically. When the lesion was completely resected, no recurrences occurred. Cancer recurred in 3 (2.8%) patients, all with a lesion greater than 15 mm (Tanabe et al, 2002). Unrecognizable submucosal spread is frequently the cause of local recurrence. The analysis of diffuse-type mucosal gastric cancer less than 20 mm in diameter macroscopically has been carried out. In patients with atrophic mucosa, the distance between macroscopic and microscopic margins was about 10 mm.

Undifferentiated mucosal cancers should not be treated by EMR as the risk of metastasis to lymph nodes is about 4.2%, and gastrectomy should be advised. Abe and colleagues (2003) removed a 42 x 30 mm malignant lesion of the lesser curvature of the cardia by "en bloc" EMR by using the IT knife. Five weeks later, laparoscopic lym-phadenectomy was carried out. Histopathologic evaluation did not detect neoplastic infiltration in the 28 lymph nodes removed (Abe et al, 2003).

If the cancer is located in a position that precludes an adequate endoscopic approach, a combined surgical-endoscopic procedure can be adopted. The use of a 15 mm trocar inserted into the stomach, through which a double channel gastroscope can be placed, has been described to perform EMR of an early cardia cancer.

The efficacy of the IT-knife in performing one piece resection of gastric lesions has been evaluated. "En-bloc"

resection rates were 82% for lesions of 10 mm, 75% for those between 11 and 20 mm, and 14% for those greater than 20 mm. No recurrences were observed. However, bleeding and perforation occurred in 22% and 5% of cases, respectively (Ohkuwa et al, 2001).

The use of the ligating device has been reported in the removal of antral lesions of s 10 mm. The maximum diameter resected was 12.8 x 11.0 mm. EMR can be carried out in the duodenum. The main application is represented by SP in familial adenomatous polypo-sis (FAP) patients, even those involving the papilla of Vater.

Constipation Prescription

Constipation Prescription

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