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Safety and feasibility of simultaneous endoscopic submucosal dissection for multiple gastric neoplasias

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Abstract

Background

Synchronous gastric neoplasms are not infrequently detected, thus endoscopic submucosal dissection (ESD) for multiple early gastric neoplasia is occasionally considered. However, there have been few investigations of the safety and feasibility of simultaneous ESD for multiple gastric lesions. This study aims to evaluate the safety and feasibility of simultaneous ESD for multiple gastric neoplasia.

Methods

A total of 1823 patients who underwent ESD for 1929 gastric adenomas or early gastric cancers were retrospectively reviewed in this study. Two hundred gastric adenomas or early gastric cancers among 94 patients were treated by ESD simultaneously (multiple group), and 1729 patients were treated with ESD for a single lesion (single group).

Results

En bloc resection (P = 0.060), complete resection (P = 0.362) and curative resection (P = 0.108) rates did not differ between the two groups. Rates of adverse events including bleeding (P = 0.317), perforation (P = 0.316) and aspiration pneumonia (P = 0.563) were not higher in the multiple group. Long-term follow-up showed more frequent local recurrence (P < 0.001), synchronous neoplasia (P = 0.041) and metachronous neoplasia (P < 0.001) per patient in the multiple group; however, local recurrence per lesion did not differ between the two groups (P = 0.103).

Conclusions

Simultaneous ESD for multiple synchronous gastric neoplasms is safe and feasible compared to single ESD. However, thorough examination for local recurrence and synchronous and metachronous neoplasia is required.

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Disclosures

Dong Hoo Joh, Chan Hyuk Park, Sungmo Jung, Seung-Ho Choi, Hyun Ki Kim, Hyuk Lee, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee, Sang Kil Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Dong Hoo Joh, Chan Hyuk Park, Sungmo Jung, Hyuk Lee, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee & Sang Kil Lee

  2. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seung-Ho Choi

  3. Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyun Ki Kim

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  1. Dong Hoo Joh
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Correspondence to Dong Hoo Joh.

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Joh, D.H., Park, C.H., Jung, S. et al. Safety and feasibility of simultaneous endoscopic submucosal dissection for multiple gastric neoplasias. Surg Endosc 29, 3690–3697 (2015). https://doi.org/10.1007/s00464-015-4139-4

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  • DOI: https://doi.org/10.1007/s00464-015-4139-4

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