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Endoscopic submucosal dissection for esophagogastric junction tumors: a single-center experience

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Abstract

Background

Surgical resection for esophagogastric junction (EGJ) tumors is more aggressive and worsens the quality of life of the patients and leads to poor prognosis even after surgery compared with tumors in other sites of the stomach. Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach. However, EGJ tumor is one of the most technically difficult lesions to resect by ESD. Therefore, this study aimed to evaluate the therapeutic outcomes of ESD for EGJ epithelial neoplasms and to assess the predictive factors for incomplete resection.

Methods

We conducted a retrospective observational study of 48 patients who underwent ESD for adenomas and early cancers of the EGJ between March 2006 and November 2015 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related adverse events were analyzed.

Results

En bloc resection, complete resection, and curative resection rates were 96, 77, and 71%, respectively. Multivariate analyses showed that the presence of ulceration was an independent predictive factor for incomplete resection (odds ratio 21.3, 95% confidence interval 1.51–298.49; p = 0.023). The procedure-related bleeding, perforation, and stenosis rates were 8, 4, and 0%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range 6–72 months), local recurrence occurred in four patients with incomplete resection.

Conclusion

ESD is an effective, safe, and feasible treatment for EGJ epithelial neoplasms. However, the complete resection rate decreases for tumors with ulceration.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health, Welfare and Family Affairs, Republic of Korea (0920050) and by the Medical Research Center Program through the National Research Foundation of Korea grant funded by the Korea government (NRF-2015R1A5A2009656).

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Authors and Affiliations

  1. Departments of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea

    Joong Keun Kim, Gwang Ha Kim, Bong Eun Lee, Chul Hong Park, Hye Kyung Jeon, Dong Hoon Baek & Geun Am Song

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  1. Joong Keun Kim
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  2. Gwang Ha Kim
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Correspondence to Gwang Ha Kim.

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Disclosures

Joong Keun Kim, Gwang Ha Kim, Bong Eun Lee, Chul Hong Park, Hye Kyung Jeon, Dong Hoon Baek, and Geun Am Song have no conflict of interest or financial ties to disclose.

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Kim, J.K., Kim, G.H., Lee, B.E. et al. Endoscopic submucosal dissection for esophagogastric junction tumors: a single-center experience. Surg Endosc 32, 760–769 (2018). https://doi.org/10.1007/s00464-017-5735-2

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  • DOI: https://doi.org/10.1007/s00464-017-5735-2

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