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Background and aims <p>Endoscopic submucosal dissection (ESD) is a minimally-invasive curative treatment for early gastric cancer (EGC). Recently, JCOG1009/1010, a multicenter, prospective, single-arm, confirmatory trial, showed that of ESD for undifferentiated early gastric cancer (UD-EGC) ≤ 2&#xa0;cm without ulceration are comparable with those of gastrectomy, resulting in the expansion of the indications of ESD for UD-EGC. Herein, we explored the factors associated with technical difficulty in ESD in patients with UD-EGC using data from JCOG1009/1010.</p> Methods <p>The inclusion criteria for JCOG1009/1010 were histologically proven undifferentiated-type adenocarcinoma, cT1aN0M0, absence of ulceration, and tumor size of &lt; 2&#xa0;cm. The technically difficult cases were defined as those with an ESD procedure time of &gt; 120&#xa0;min, intraoperative perforation, or incomplete <i>en bloc</i> resection. We compared difficult and non-difficult ESD cases and performed multivariable analysis.</p> Results <p>Of 346 patients enrolled in JCOG1009/1010, 332 were analyzed. Technical difficulties were experienced in 70 (21%) patients: procedure &gt; 120&#xa0;min (55 patients, intraoperative perforation (18 patients), and incomplete <i>en bloc</i> resection (four patients). Upper location (versus [vs.] lower, odds ratio [OR]: 4.20, 95% confidence interval [CI]: 1.52–11.64, p = 0.006), post-eradication of <i>Helicobacter pylori</i> infection (vs. presence, OR: 0.40, 95% CI: 0.17–0.98, p = 0.045), and absence of atrophy in the background mucosa around the lesion (vs. presence, OR: 2.56, 95% CI: 1.22–5.41, p = 0.013) were independent factors significantly associated with technical difficulty in ESD.</p> Conclusion <p>Upper location, <i>H. pylori</i> infection, and absence of atrophy in the background mucosa around the lesion were associated with technical difficulty in ESD for UD-EGC.</p> Graphical abstract <p></p>

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Factors associated with technical difficulty in endoscopic submucosal dissection for undifferentiated early gastric cancer: post hoc analysis of JCOG1009/1010

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Tomohiro Mitsui,
  • Kohei Takizawa,
  • Tomohiro Kadota,
  • Gakuto Ogawa,
  • Hiroyuki Ono,
  • Noriaki Hasuike,
  • Ryu Ishihara,
  • Toshiyuki Yoshio,
  • Tsuneo Oyama,
  • Daisuke Kikuchi,
  • Yasuhiro Inokuchi,
  • Yosuke Toya,
  • Takuto Hikichi,
  • Hiromitsu Kanzaki,
  • Waku Hatta,
  • Takaki Yoshikawa,
  • Seiichiro Abe,
  • Masanori Terashima,
  • Tomonori Yano

摘要

Background and aims

Endoscopic submucosal dissection (ESD) is a minimally-invasive curative treatment for early gastric cancer (EGC). Recently, JCOG1009/1010, a multicenter, prospective, single-arm, confirmatory trial, showed that of ESD for undifferentiated early gastric cancer (UD-EGC) ≤ 2 cm without ulceration are comparable with those of gastrectomy, resulting in the expansion of the indications of ESD for UD-EGC. Herein, we explored the factors associated with technical difficulty in ESD in patients with UD-EGC using data from JCOG1009/1010.

Methods

The inclusion criteria for JCOG1009/1010 were histologically proven undifferentiated-type adenocarcinoma, cT1aN0M0, absence of ulceration, and tumor size of < 2 cm. The technically difficult cases were defined as those with an ESD procedure time of > 120 min, intraoperative perforation, or incomplete en bloc resection. We compared difficult and non-difficult ESD cases and performed multivariable analysis.

Results

Of 346 patients enrolled in JCOG1009/1010, 332 were analyzed. Technical difficulties were experienced in 70 (21%) patients: procedure > 120 min (55 patients, intraoperative perforation (18 patients), and incomplete en bloc resection (four patients). Upper location (versus [vs.] lower, odds ratio [OR]: 4.20, 95% confidence interval [CI]: 1.52–11.64, p = 0.006), post-eradication of Helicobacter pylori infection (vs. presence, OR: 0.40, 95% CI: 0.17–0.98, p = 0.045), and absence of atrophy in the background mucosa around the lesion (vs. presence, OR: 2.56, 95% CI: 1.22–5.41, p = 0.013) were independent factors significantly associated with technical difficulty in ESD.

Conclusion

Upper location, H. pylori infection, and absence of atrophy in the background mucosa around the lesion were associated with technical difficulty in ESD for UD-EGC.

Graphical abstract