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[Gastric cancer 512]

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À§¾Ï ³»½Ã°æ Ä¡·á ÈÄ ÀϺΠȯÀÚ¿¡¼­ expanded criteria¿¡ ÇØ´çÇÏ´Â ¼Ò°ßÀÌ ³ª¿É´Ï´Ù. Å©±â 3cm ÀÌÇÏÀÌ°í minute submucosa invasionÀÌ ÀÖ´Â °æ¿ì´Â expanded criteria¿¡ ¸¸Á·ÇÏ¿© ÃßÀû°üÂûÀ» ±ÇÇÏ´Â °ÍÀ¸·Î µÇ¾î ÀÖ½À´Ï´Ù.

This is a very famous table for expanded indication. Three boxes in group B are expanded indications for ESD. However, the yellow box, group C, is considered to be an expanded indication by some endoscopists. So, there are two different definitions for expanded indications of ESD. Only B versus B and C. We need to be very careful when we read literatures on expanded indications.

There is an important thing that we sometimes forget. Indications are different from criteria. Indication is something that we consider before the treatment. Criteria is something we consider after the treatment. In this regard, selection of patients for ESD can be different from selection of patients for additional surgery after ESD.

This is an algorithm from a Japanese literature. ESD candidates are selected by the absolute indications. Expanded indications are not considered for ESD in this flowchart. After ESD and histological assessment, you can see the concept of expanded criteria. When the lesion is slightly over the standard guideline criteria, you can choose close follow-up rather than additional surgery. So this group of patients was originally considered as an absolute indication, but after ESD they were changed into expanded criteria. So, indication and criteria is different in terms of the timing. Indication is before ESD, criteria is after ESD. We should not confuse them. But until now, the two terminologies are used interchangeably. I don¡¯t like it.

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Stomach ESD
Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 22 mm (2) vertical diameter, 19 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 100 §­) (pT1b)
7. Resection margin : free from carcinoma(N), safety margin : distal 7 mm, proximal 5 mm, anterior 4 mm, posterior 10 mm, deep 200 §­ (sm only)
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

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© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.