Common Procedure for Gastric Cancer Shows Promise for North American Patients

By Hillary Eames
Tuesday, September 8, 2020

Endoscopic submucosal dissection was shown to be highly effective at removing superficial gastric tumors and is a viable option for patients around the globe.

Stomach cancer rates in the United States have decreased significantly in the past decades; until the late 1930s, the disease claimed the highest number of cancer deaths in the U.S. Currently, stomach cancer ranks 15th among the most common cancer diagnoses, according to the National Cancer Institute, yet remains one of the most widespread and deadliest types of cancer diagnosed throughout the world.

Gastric cancer is especially prevalent in Asian countries, and as such, preventive measures are necessary to diagnose and treat neoplasia in earlier stages. In Japan, endoscopic submucosal dissection (ESD) was developed as a form of organ-sparing resection of early gastric cancer. It is now considered the standard of care for many Asian countries, and the European Society of Gastrointestinal Endoscopy recommends it strongly, as well. While the procedure is less common in North America than it is in other countries, a recent manuscript published online in Clinical Gastroenterology and Hepatology shows that ESD may be a viable option for American patients.

Results As Seen In North American Patients

The retrospective study observed data from 347 patients from 25 centers in North America who underwent ESD for superficial gastric tumors. Led by Saowanee Ngamruengphong, MD, Assistant Professor of Medicine at Johns Hopkins University School of Medicine and gastroenterologist at The Johns Hopkins Hospital in Baltimore, the researchers found that approximately 92% of patients who received ESD had en-bloc resection and approximately 81% received resection across all lesions that were successful at curing patients of superficial gastric tumors.

Local recurrence of tumors occurred in 3.9% of patients, and only after noncurative resection. Complications from the procedure were relatively low, as well, with 7% of patients experiencing perforations during the procedure and more than 80% of them successfully managed endoscopically. Delayed bleeding occurred in less than 3% of patients, and surgery was required for adverse effects in just above 1% of cases. There were no patient mortalities or delayed perforations related to the procedure. This study is a significant addition to the research available concerning ESD outcomes on North American patients, as the amount of data remain comparatively low with smaller and single-center studies from the U.S.

Making ESD Readily Available in America

A more common procedure in North America is endoscopic mucosal resection (EMR), but its setbacks may outweigh its benefits compared to ESD. EMR uses submucosal injection, suction and snare removal of lesions, and in doing so often results in piecemeal resections. In comparison, ESD is able to more effectively remove larger or deeper lesions and also minimize local recurrence. A meta-analysis published in the World Journal of Gastrointestinal Endoscopy reported that ESD had an en bloc resection rate of 92% and a histologically complete resection rate of 82%—both numbers significantly higher than EMR (52% and 42%, respectively).

The benefits of ESD are evident; however, the procedure is still not readily available to gastric cancer patients in the United States. The method is highly specialized and challenging to perform, and the learning curve is steep. Once mastered, the procedure is time-consuming, and few hospitals in the U.S. offer ESD to patients. Case numbers that would require the technique are currently low in the United States, as well. However, studies such as Dr. Ngamruengphong’s may help to increase awareness of the procedure’s benefits to patients and encourage facilities to invest in ESD. Dr. Ngamruengphong reported in a press release that an increasing number of endoscopists are receiving training in ESD as the procedure gains traction in the U.S.