After 47 patients (49 lesions) were excluded because the lesions were outside the indications, there were 412 patients (515 lesions) included in the final group of subjects. Analysis was performed retrospectively for these lesions. Our indications of ESD were based on the indications of the lesions and by the physical condition of the patients (comorbidity, life expectancy due to other diseases, and PS) (Fig. 1). Early gastric cancers were classified according to the Guidelines for Diagnosis and Treatment of Carcinoma of the Stomach of the Japanese Gastric Cancer Association (JGCA).16–18 The categories of lesions

used in this study were guideline lesions and lesions in the expanded indications. Regardless of the macroscopic Histone Methyltransferase inhibitor type, a “guideline lesion” was defined as: (i) ≤ 2 cm; (ii) differentiated mucosal carcinoma that was flat or depressed; and (iii) without ulceration. Regardless of the macroscopic type, a “lesion selleck inhibitor in the expanded

indications” was (i) differentiated mucosal carcinoma ≥ 2 cm or ≤ 3 cm with ulceration, or (ii) poorly or undifferentiated mucosal carcinoma ≤ 2 cm without ulceration. All other lesions were defined as “outside the indications. The macroscopic type of early gastric cancer was classified according to the JGCA classification of superficial neoplastic lesions. The histological type and depth of invasion were classified according to the JGCA Japanese classification of gastric cancer.17 For the treatment outcomes, MCE公司 the lesions were classified as resected en bloc, if they were thought to be endoscopically resected, or completely resected en bloc (en bloc plus R0 resection), if the horizontal and vertical margins were histologically negative for tumor and there was

no lymph–vascular invasion. Comorbidities at the time of ESD were examined for each patient (some patients had multiple comorbidities) and their prevalence rates were investigated: cardiovascular disease (hypertension, ischemic heart diseases such as myocardial infarction and angina pectoris, and cerebral infarction), lipidosis (diabetes and hyperlipidemia), liver disease (cirrhosis), and kidney disease (chronic renal dysfunction). The following complications were examined: perforation of the stomach during ESD, postoperative pneumonia, and postoperative hemorrhage beyond 1 week after surgery. The PS at ESD was classified by grade based on the Eastern Cooperative Oncology Group scale19 (Table 1). As in the indications for chemotherapy, the patients had to have a PS of 0, 1, or 2.18 For patients with senile dementia, the decision to perform ESD was made only if gastric cancer was thought to be the prognostic factor of survival. That also applied to patients whose families provided consent. In principle, elderly patients were treated the same way as the non-elderly patients in the obtaining of informed consent.