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Body Mass Index and Clinical Outcomes from Endoscopic Submucosal Dissection of Gastric Neoplasia

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Abstract

Background and Aim

Association between obesity and endoscopic resection outcomes has not been investigated. We sought to determine the clinical impact of obesity in patients who underwent endoscopic submucosal dissection (ESD) for gastric neoplasia.

Methods

A total of 1571 consecutive patients with gastric neoplasia who underwent ESD between December 2010 and March 2016 were enrolled in this study. We retrospectively analyzed 1181 cases that were divided into three groups based upon body mass index (BMI, kg/m2) according to the criteria for Asia-Pacific populations: normal (<23, n = 411), overweight (≥23 and <25, n = 312), and obese (≥25, n = 458). Demographics, endoscopic findings, pathologic results, and clinical outcomes were analyzed.

Results

No significant differences were observed between the three BMI groups in the following measures: the en-bloc resection rate, the complete resection rate, lymphovascular involvement or submucosal invasion of tumor cells, and adverse events. However, when comparing the obese and overweight groups with the normal group, mean procedure time was longer (P = 0.001) and the percentage of cases requiring more than 30 min, which was the overall mean procedure time, was greater (60.7, 53.2, and 50.1%, respectively; P = 0.006). The significantly associated factors with procedure durations longer than 30 min were obesity, longitudinal and circumferential location, large resection size (≥4 cm), cancer pathology, and submucosal layer invasion. In multivariate analyses, obesity was an independent predictor of long procedure time for gastric ESD.

Conclusion

Being obese or overweight did not directly affect clinical outcomes in gastric ESD. However, obesity was significantly associated with long procedure time. Our results suggest that gastric ESD can be performed safely and effectively in obese patients.

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Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science, and Technology (NRF-2013R1A1A2007985) and by a grant from the Global Research and Development Center through the National Research Foundation of Korea, which was funded by the Ministry of Science, ICT, and Future Planning (NRF-2011-0031644).

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Author notes

  1. Donghoon Kang and Sung Eun Ha have contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea

    Donghoon Kang, Sung Eun Ha, Jae Myung Park, Seung Bae Yoon, Han Hee Lee, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho & Myung-Gyu Choi

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  1. Donghoon Kang
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  2. Sung Eun Ha
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Correspondence to Jae Myung Park.

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Kang, D., Ha, S.E., Park, J.M. et al. Body Mass Index and Clinical Outcomes from Endoscopic Submucosal Dissection of Gastric Neoplasia. Dig Dis Sci 62, 1657–1665 (2017). https://doi.org/10.1007/s10620-017-4560-8

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