Endoscopic Submucosal Dissection for Gastric Neoplasm at an Outpatient Clinic: Efficacy and Safety

cancer is the most common malignancy in Korea. In recent years, mortalities associated with gastric cancer have decreased markedly in some Asian countries due to health-care policies that introduced screening tests for early detection of gastric cancer. Since curative treatment is possible when tumors are resectable, screening modalities that detect gastric cancers when they are still resectable can increase long-term survival rates. Although surgical resection is the standard method of treatment, patients diagnosed with early gastric cancer (EGC) can be resected endoscopically and early diagnosis , allowing endoscopic resection, is therefore important. Endoscopic mucosal resection was introduced in the 1990s, and endoscopic submucosal dissection (ESD) in 2003. Currently , ESD is becoming the main procedure for the resection of EGC and many reports showed that the endoscopic and oncologic outcome of endoscopic treatment in gastric neo-plasm was acceptable in terms of curability and safety. Usually, ESD takes place on admission because of safety issue such as the prevention and prompt hemostasis for post-procedure bleeding. The rationales of day-procedure of ESD include low frequency of delayed complications, cost-beneficial policy for the patients, and early return to work place. However , there are several advantages of admission such as staged diet after ESD, removal of anxiety for the delayed complications , proper management for delayed complications, and pathologic confirm during admission having a chance to take additional treatment. Duration of admission day for ESD in gastric neoplasm is different in each center. The reasons of difference about period of hospitalization are dependent to the policy of center, such as timing of starting diet and performing second-look endos-copy. In addition, it is easy to control complications when that is happened during admission and this can make comfort to patients and endoscopists. When we think about cost benefits for admission, ESD procedure at an outpatient clinic can be considered in selected patients. However, there are no studies about the efficacy and safety about one day procedure of ESD until now. This Korean study showed the results of therapeutic safety and efficacy of ESD in outpatient basis for the treatment of small sized gastric dysplasia and EGC which were located at the antrum. 7 In this study, even though number of enrolled case was small and design was retrospective, complications such as bleeding and perforation were similar between inpa-tient group and outpatient group. 7 Intraoperative and postoperative bleeding is the most common complication of ESD …