Endoscopic submucosal dissection for early gastric cancer on the lesser curvature in upper third of the stomach is a risk factor for postoperative delayed gastric emptying
Advances in Endoscopic submucosal dissection (ESD) technology have established ESD for early gastric cancer as a safe and stable technique. However, ESD may induce delayed gastric emptying and the cause of food residue retention in the stomach after ESD is not clear. This study aimed to clarify risk factors for delayed gastric emptying with food retention after gastric ESD.
We retrospectively examined for food residue in the stomach 1 week after ESD was performed for early gastric carcinoma at Osaka Saiseikai Nakatsu Hospital from February 2008 to November 2016.
Food residue was observed in 68 (6.1%) of 1114 patients who underwent gastric ESD. The percentage of lesions located on the lesser curvature of the upper third of the stomach was 45.6% (31/68) in the food residue group and 3.5% (37/1046) in the non-food residue group, which was significantly different (P < 0.01). Multivariate logistic regression analysis revealed that lesions on the lesser curvature of the upper third of the stomach (Odds ratio [OR] 23.31, 95% confidence interval [CI] 12.60–43.61, P < 0.01), post-ESD bleeding (OR 4.25, 95%CI 1.67–9.80, P < 0.01), submucosal invasion (OR 2.80, 95%CI 1.34–5.63, P < 0.01), and age over 80 years (OR 2.34, 95%CI 1.28–4.22, P < 0.01) were independent risk factors for food retention after gastric ESD. Of the 68 patients, 3 had food residue in the stomach on endoscopic examination for follow-up observation after the ESD ulcer had healed.
Delayed gastric emptying with food retention after gastric ESD was associated with lesions located in the lesser curvature of the upper stomach, submucosal invasion of the lesion, age older than 80 years, and post-ESD bleeding, though it was temporary in most cases.
KeywordsEndoscopic submucosal dissection Gastric emptying Food residue Lesser curvature Post-ESD bleeding Submucosal invasion
The authors wish to thank Dr. Yoshiko Ohara and Dr. Daisuke Watanabe at Kobe University Hospital for refining our manuscript.
Compliance with ethical standards
Tetsuya Yoshizaki, Daisuke Obata, Yasuhiro Aoki, Norihiro Okamoto, Hiroki Hashimura, Chise Kano, Megumi Matsushita, Atsushi Kanamori, Kei Matsumoto, Masahiro Tsujimae, Kenji Momose, Takaaki Eguchi, Shunsuke Okuyama, Hiroshi Yamashita, Mikio Fujita, Akihiko Okada have no conflicts of interest or financial ties to disclose.
- 3.Toyonaga T, Man-i M, East JE, Nishino E, Ono W, Hirooka T, Ueda C, Iwata Y, Sugiyama T, Dozaiku T, Hirooka T, Fujita T, Inokuchi H, Azuma T (2013) 1635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 27:1000–1008CrossRefPubMedGoogle Scholar
- 5.Kim SG, Ji SM, Lee NR, Park SH, You JH, Choi IJ, Lee WS, Park SJ, Lee JH, Seol SY, Kim JH, Lim CH, Cho JY, Kim GH, Chun HJ, Lee YC, Jung HY, Kim JJ (2017) Quality of life after endoscopic submucosal dissection for early gastric cancer: a prospective multicenter cohort study. Gut Liver 11:87–92CrossRefPubMedGoogle Scholar
- 10.Uehara R, Isomoto H, Minami H, Yamaguchi N, Ohnita K, Ichikawa T, Takeshima F, Shikuwa S, Nakao K (2013) Characteristics of gastrointestinal symptoms and function following endoscopic submucosal dissection and treatment of the gastrointestinal symptoms using rikkunshito. Exp Ther Med 6:1083–1088CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, Hocking MP, Quigley EM, Koch KL, Tokayer AZ, Stanghellini V, Chen Y, Huizinga JD, Ryden J, Bourgeois I, McCallum RW (2000) Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 95:1456–1462CrossRefPubMedGoogle Scholar
- 16.Waseda Y, Doyama H, Inaki N, Nakanishi H, Yoshida N, Tsuji S, Takemura K, Yamada S, Okada T (2014) Does laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors preserve residual gastric motility? Results of a retrospective single-center study. PloS ONE 9:e101337CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Kuwahara T, Takahashi A, Takahashi Y, Kobori A, Miyazaki S, Takei A, Fujino T, Okubo K, Takagi K, Fujii A, Takigawa M, Watari Y, Hikita H, Sato A, Aonuma K (2013) Clinical characteristics and management of periesophageal vagal nerve injury complicating left atrial ablation of atrial fibrillation: lessons from eleven cases. J Cardiovasc Electrophysiol 24:847–851CrossRefPubMedGoogle Scholar
- 19.O’Grady G, Du P, Cheng LK, Egbuji JU, Lammers WJ, Windsor JA, Pullan AJ (2010) Origin and propagation of human gastric slow-wave activity defined by high-resolution mapping. Am J Physiol Gastrointest Liver Physiol 299:G585-592Google Scholar