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Surgical Endoscopy

, Volume 34, Issue 2, pp 880–887 | Cite as

Clinical outcomes of endoscopic submucosal dissection for lesions on the proximal location between remnant and entire stomach

  • Su Jin Kim
  • Cheol Woong ChoiEmail author
  • Dae Hwan Kang
  • Hyung Wook Kim
  • Su Bum Park
  • Hyeong Seok Nam
  • Dae Gon Ryu
Article

Abstract

Background

Tumors located on the proximal stomach are associated with a longer procedure time and lower en-block resection of endoscopic submucosal dissection (ESD). Additionally, it is more difficult to perform ESD for lesions after distal gastrectomy because of the narrow inner space. We aimed to evaluate the therapeutic outcomes of ESD for lesions on the remnant stomach compared with those on the upper third of the entire stomach.

Methods

A total of 135 patients with a neoplasm located on the proximal stomach who received ESD between Aug 2008 and Dec 2016 were enrolled. We retrospectively reviewed en-bloc resection rate, complete resection rate, and complication rate according to whether distal gastrectomy was performed. Clinical outcomes were compared among the 1:2 propensity-matched groups.

Results

Between the remnant stomach and entire stomach, the en-bloc [92% (23/25) and 92.0% (46/50), respectively; P = 1.000] and complete resection [84% (21/25) and 88.0 (44/50), respectively; P = 0.723] rates were not significantly different. In patients with lesions that indicated ESD, there was no significant difference in en-bloc and complete resection rates. In a multivariable analysis, submucosal fibrosis [odds ratio (OR) 5.9, 95% confidence interval (CI) 1.1–30.7] and submucosa invasive cancer (OR 10.1, 95% CI 1.4–74.3) were independent risk factors for incomplete resection.

Conclusions

ESD is a feasible therapeutic option for lesions located on the proximal stomach regardless the operation history of distal gastrectomy. However, the complete resection rate decreases for lesions with submucosal fibrosis or the submucosa invasion.

Keywords

Endoscopic submucosal dissection Neoplasm Curative resection 

Notes

Compliance with ethical standards

Disclosures

Su Jin Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam, Dae Gon Ryu have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Su Jin Kim
    • 1
  • Cheol Woong Choi
    • 1
    Email author
  • Dae Hwan Kang
    • 1
  • Hyung Wook Kim
    • 1
  • Su Bum Park
    • 1
  • Hyeong Seok Nam
    • 1
  • Dae Gon Ryu
    • 1
  1. 1.Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsan-siKorea

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