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Comparison of endoscopic treatments for small gastric adenomas

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Abstract

Background

Gastric adenomas can be successfully treated with endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The aim of this study was to evaluate and compare the efficacy of ESD and EMR with circumferential precutting (EMR-P) in the treatment of small gastric adenomas.

Methods

This study included 1014 gastric adenomas ≤ 15 mm in diameter treated with ESD or EMR-P from 2012 to 2019, retrospectively. Propensity score matching between the ESD and EMR-P groups (1:1 to 3:1) was performed according to age, sex, tumor size, tumor location (upper, middle, and lower thirds), morphology, and preprocedural histology. The procedure time and the rates of en bloc resection, complete resection, adverse events, and local recurrence were compared between the two groups.

Results

After propensity score matching, 478 lesions (ESD: 295, EMR-P: 183) were analyzed. The rates of en bloc resection (94.9% vs. 93.4%, p = 0.498), complete resection (93.6% vs. 90.2%, p = 0.177), bleeding (8.1% vs. 3.8%, p = 0.063), and local recurrence (0.0% vs. 1.4%, p = 0.185) did not significantly differ between the two groups. The procedure time was significantly longer for ESD than for EMR-P (p < 0.001). In the EMR-P group, the complete resection rate was significantly lower in the upper third than in the middle and lower thirds (p < 0.001).

Conclusion

EMR-P is as effective as ESD for the treatment of small gastric adenomas. However, the efficacy of EMR-P is lower for gastric adenomas in the proximal stomach.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Jae Ho Cho, Cheol Min Shin, Hyuk Yoon, Young Soo Park, Nayoung Kim & Dong Ho Lee

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  1. Jae Ho Cho
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Contributions

CMS conceptualized and designed the study outline, acquired data, and supervised the analysis of data. JHC drafted and revised the article. HY and YSP performed analysis and interpretation of the data. NK and DHL revised the article for important intellectual contents. All authors have reviewed and approved the final article.

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Correspondence to Cheol Min Shin.

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Drs. Jae Ho Cho, Cheol Min Shin, Hyuk Yoon, Young Soo Park, Nayoung Kim, and Dong Ho Lee have no conflicts of interest or financial ties to disclose.

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Cho, J., Shin, C., Yoon, H. et al. Comparison of endoscopic treatments for small gastric adenomas. Surg Endosc 36, 3920–3931 (2022). https://doi.org/10.1007/s00464-021-08710-9

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