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Is endoscopic ultrasonography (EUS) needed for deciding the indication for endoscopic submucosal dissection (ESD) of early gastric carcinoma? - the significance of diagnosis of the invasive depth and lymphnode metastasis of gastric carcinoma by EUS



Is endoscopic ultrasonography (EUS) needed for deciding the indication for endoscopic submucosal dissection (ESD) of early gastric carcinoma? - the significance of diagnosis of the invasive depth and lymphnode metastasis of gastric carcinoma by EUS



Stomach and Intestine (Tokyo) 40(5): 779-790



Accuracy of EUS for determining the invasive depth in cases of gastric carcinoma resected by EMR was 86% (31/36).Accuracy of EUS was 77% in mucosal invasion, 60% in submucosal invasion and was 85% in proper muscle layer or more invasion in the analysis of 275 gastric carcinoma cases resected by EMR and surgery.We think that EUS is significant in gastric carcinoma cases in which the lesion is not included in the clinical practice guidelines for EMR.1) When the lesion is 2 cm or more in size, without ulceration, limited in the mucosa and is a well to moderately differentiated adenocarcinoma in histology, and when the third hyperechoic layer is unaffected.2) When the lesion is 3 cm or less in size, with ulceration, limited in the mucosa and is a well to moderately differentiated adenocarcinoma in histology, the depth of tissue defect of ulceration should be evaluated by EUS. Attention concerning perforation should be paid in ESD of early gastric carcinoma when EUS reveals that the lesion has an ulcer whose tissue defect within itself is the proper muscle or more.3) When the finding of EUS of slight submucosal invasion is budding-like growth from the second hypoechoic layer to the third hyperechoic layer.In other diagnostic aspects of EUS, diagnostic ability of EUS for lymphnode metastasis was 54% in sensitivity, 93% in specificity and 81% in accuracy. The existence of false negative cases should be resolved.After we understand the diagnostic ability of EUS, we should use it when deciding the indication for ESD in early gastric carcinoma beyond the clinical practice guidelines for the use of EMR.

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