Background:Repeat endoscopic mucosal resection(EMR) to cure locally recurrent early gastric cancer(EGC) is difficult to perform because the initial EMR causes submucosal fibrosis;however,ESD allows submucosal dissection through the fibrosis and provides an en bloc specimen.Objective:The objective was to determine the safety and efficacy of ESD and compare the results to historical controls.Design:This was a retrospective,case-control study.Patients:We used our prospectively entered database(1993-2003) to identify 64 patients who had locally recurrent EGC after EMR.Main Outcome Measurements:We defined the resections as curative when the lateral and vertical margins were free of cancer and repeat endoscopy showed no recurrent disease.Results:Among 46 patients who underwent ESD,41(89.1%) en bloc resections were achieved compared to none in 18 conventional procedures(P<.0001) .The specimen of 1 lesion(2.4%) out of 41 en bloc resections was histologically nonevaluable,compared with 10 lesions(43.4%) in 23 piecemeal resections(P <.0001) .Three residual tumors(27.3%) were found in the 11 nonevaluable specimens.Three perforations occurred during ESD;all were successfully treated endoscopically with endoclips.Limitations:The limitation of the study was retrospective design.Conclusions:ESD provides high en bloc resection rate for locally recurrent EGC after previous EMR.In turn,en bloc resections allow precise histological staging to be assessed and prevent residual disease and recurrence.
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