Endoscopic submucosal dissection treatment on the early gastric cancer in Mongolia
Battulga A. MD Head of endoscopic department, Ulaanbaatar Songdo hospital
Ichiro Oda. MD Endoscopic division of National Cancer Center of Japan
Narantsatsralt J. MD Endoscopic doctor UBSD hospital
Davaadorj D. MD, PhD Vice director of National Medical University of Mongolia, UBSD hospital
Erdene-Ochir Y. MD, PhD Chairman of Surgical Clinic, National Cancer Center of Mongolia
Tuul B. MD pathologic doctor UBSD Hospital
Bolor O. MD UBSD hospital
Bayasgalan L. MD UBSD hospital
Oyunchimeg J. MD Endoscopic doctor, National Cancer Center of Mongolia
Background
In Mongolian cancer statistics prevalence of most common cancers are gastric Cancer is the second leading cause of mortality in Mongolia. In per 100,000 population for men second place (45.5) and for female third place (20.1). Seen in Mongolia gastric cancer is early diagnosis and treatment in the Mongolian is of high importance.
Introduction
ESD (endoscopic submucosal dissection) was performed for the first time in Mongolia in October 2006 by a team of doctors from National Cancer Center of Mongolia, under the guidance of Ichiro Oda, endoscopy doctor of National Cancer Center of Japan. In October 2008 a team of Mongolian doctors performed the ESD without supervision for the first time at Ulaanbaatar Songdo.
Methods
For the period 2008 to 2014, in UB Songdo of endoscopic department Endoscopic submucosal dissection completed operated 67 cases, There case’s images, videos, and preoperative and postoperative biopsy solution using statistical processing is done.
Result
A total of 67 ESD procedures were performed. According to age, sex ratio of the total from 50-69 is highest in the age and there are more men (69%) of early gastric cancer. The indication were a incidence rate of the cancer location was for upper part (U) 58,2% (36 cases), for middle part (M) 17,9% (12 cases), for cancer located on the lower part (L) was 23,9% (19 cases) (Fig.1.). In the stomach, the mean diameter of the lesions was 10.2 mm (0.5–35.0 mm) (Fig.2.). 36 lesions were type IIc (56.7%), 14 were type IIa, a type IIa+IIc 10 cases and seven cases IIc (Fig.3.), with 54 cases either 80.5% being well differentiated (Fig.4.). Complication in 2 cases bleeding after surgery, submucoseal invasive 2 cases and no more perforation cases.
Discussion
In our study early gastric cancer diagnosed patients for ages 50-69 and similar as study of Sadettin Hulagu, Omer Senturk. Our study early gastric cancers are located in the location would be at the top of 58.2% and 17.9% in the middle, and lower part 23.9% in Japan, compared with the upper part of the stomach against the high rate of cancer. In japan early gastric cancer located upper 6%, middle 56%, lower part 38% of stomach.(New surgery. Author Yasuo Idezuki, Furuse Akira etc). In Brazil ESD case early gastric cancers are located in antrum 8 case, in body 4 case, in upper 3 cases ( Dalton Marques Chaves, Eduardo G. H. de Moura) different as our research. Macroscopically type IIc incidence was 36 being the highest rate with 53,7%. Other incidence forms of type I was a 1, a type IIa-14, a type IIb-7, a type IIa+IIc – 9 cases. Similar as Dalton Marques Chaves, Eduardo G. H. de Moura (IIa+IIc 8 cases, IIa 4 cases, IIc 4 cases.). In our study for shape early gastric cancer the mean 11.2 (0.5-3.5 cm) Sao Paulo university of research are similar.
Conclusion
On the pathology of before ESD detected 6 cases of High grade dysplasia. But after ESD 4 were well differentiated adenocarcinoma. Actually high grade dysplasia can be the indication of the ESD.
58.2% of the total ESD cases were located on the upper (U). There are technically difficult location is high in our cases.
Reference
Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer - initial experience of a western center
1) “Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer - initial experience of a western center” Dalton Marques Chaves,I Fauze Maluf Filho,II Eduardo G. H. de Moura,I Marcos Eduardo Lera dos Santos,I Livia Ronise Garcia Arrais,I Fabio Kawaguti,II and Paulo SakaiII fromhttp://www.ncbi.nlm.nih.gov/pmc/articles
2) World journal of Gastroenterology “Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers” Sadettin Hulagu, Omer Senturk, Cem Aygun, Orhan Kocaman, Altay Celebi, Tolga Konduk, Deniz Koc, Goktug Sirin, Ugur Korkmaz, Ali Erkan Duman, Neslihan Bozkurt, Gokhan Dindar, Tan Attila, Yesim Gurbuz, Orhan Tarcin, Cem Kalayci from World journal of Gastroenterology
3) Endoscopic submucosal dissection of early gastric cancer Ki Joo Kang,* Kyoung-Mee Kim,† Byung-Hoon Min,* Jun Haeng Lee,* and Jae J. Kim. From http://www.ncbi.nlm.nih.gov/pmc/articles
4) New surgery. Author Yasuo Idezuki, Furuse Akira etc
5) Treatment of gastric cancer guideline in Japan. 2004
