Clinical outcomes of endoscopic submucosal dissection for lesions on the proximal location between remnant and entire stomach
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.
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.
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.
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.
KeywordsEndoscopic submucosal dissection Neoplasm Curative resection
Compliance with ethical standards
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.
- 2.Jun JK, Choi KS, Lee HY, Suh M, Park B, Song SH, Jung KW, Lee CW, Choi IJ, Park EC, Lee D (2017) Effectiveness of the Korean national cancer screening program in reducing gastric cancer mortality. Gastroenterology 152(1319–1328):e1317Google Scholar
- 3.Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, Kim JM, Kim YI, Ryu KW, Kong SH, Kim HI, Jung HY, Kim YS, Zang DY, Cho JY, Park JO, Lim DH, Jung ES, Ahn HS, Kim HJ, Committee on Stomach Cancer Guideline D (2014) Synopsis on clinical practice guideline of gastric cancer in Korea: an evidence-based approach. Korean J Gastroenterol 63:66–81CrossRefGoogle Scholar
- 4.Choi IJ, Lee JH, Kim YI, Kim CG, Cho SJ, Lee JY, Ryu KW, Nam BH, Kook MC, Kim YW (2015) Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointest Endosc 81(333–341):e331Google Scholar
- 12.(2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112Google Scholar
- 18.Takenaka R, Kawahara Y, Okada H, Tsuzuki T, Yagi S, Kato J, Ohara N, Yoshino T, Imagawa A, Fujiki S, Takata R, Nakagawa M, Mizuno M, Inaba T, Toyokawa T, Sakaguchi K (2008) Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 67:359–363CrossRefGoogle Scholar
- 19.Yabuuchi Y, Kakushima N, Takizawa K, Tanaka M, Kawata N, Yoshida M, Kishida Y, Ito S, Imai K, Ishiwatari H, Hotta K, Matsubayashi H, Ono H (2018) Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. J Gastroenterol 67:359–363Google Scholar
- 24.Yoshida M, Takizawa K, Suzuki S, Koike Y, Nonaka S, Yamasaki Y, Minagawa T, Sato C, Takeuchi C, Watanabe K, Kanzaki H, Morimoto H, Yano T, Sudo K, Mori K, Gotoda T, Ono H (2017) Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 87:1231–1240CrossRefGoogle Scholar
- 26.Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 63:243–249CrossRefGoogle Scholar
- 30.Kikuchi D, Iizuka T, Hoteya S, Yamada A, Furuhata T, Yamashita S, Domon K, Nakamura M, Matsui A, Mitani T, Ogawa O, Watanabe S, Kaise M (2013) Usefulness of magnifying endoscopy with narrow-band imaging for determining tumor invasion depth in early gastric cancer. Gastroenterol Res Pract 2013:217695PubMedPubMedCentralGoogle Scholar
- 31.Iguchi Y, Niwa Y, Miyahara R, Nakamura M, Banno K, Nagaya T, Nagasaka T, Watanabe O, Ando T, Kawashima H, Ohmiya N, Itoh A, Hirooka Y, Goto H (2009) Pilot study on confocal endomicroscopy for determination of the depth of squamous cell esophageal cancer in vivo. J Gastroenterol Hepatol 24:1733–1739CrossRefGoogle Scholar