Effect of Laser Irradiation for Residual Lesions of Early Gastric Carcinoma after Endoscopic Mucosal Resection

Abstract

Endoscopic mucosal resection (EMR) for mucosal gastric carcinoma without lymph node metastases has been widely accepted as a curative procedure in Japan. We consider patients with elevated type well-differentiated adenocarcinoma less than 20 mm in size, as well as those with depressed type intramucosal carcinoma without ulcer and less than 10 mm in size, to be absolute indications for treatment by EMR. In this study, we evaluated 26 patients (68.4±9.7yrs) with absolute adaptive lesions who underwent EMR as an initial treatment, resulting in incomplete resection of lesions. We performed laser therapy on patients with residual lesions, and examined the effects of this treatment. Eighteen cases with elevated type lesions (90%) have not exhibited recurring lesions treated by initial laser therapy alone following EMR over a period of 24 months. However, among patients with depressed type lesions, only 1 (16.7%) did not experience recurrence. There was a significant difference between the two groups (p<0.001). These recurring lesions were treated by additional laser therapy. The results were more satisfactory in patients with elevated type lesions (95.5%) than in patients with depressed type lesions (80%). No patient died of gastric cancer during follow-up. Endoscopic laser irradiation is useful in treating patients with residual lesions after EMR.