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Comparative Study
. 2013 Nov;28(6):687-93.
doi: 10.3904/kjim.2013.28.6.687. Epub 2013 Oct 29.

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

Mi Young Jang  1 , Jin Woong Cho, Wang Guk Oh, Sung Jun Ko, Shang Hoon Han, Hoon Ki Baek, Young Jae Lee, Ji Woong Kim, Gum Mo Jung, Yong Keun Cho
Affiliations
Comparative Study

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

Mi Young Jang et al. Korean J Intern Med. 2013 Nov.

Abstract

Background/aims: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD.

Methods: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study.

Results: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%.

Conclusions: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Keywords: Neoplasms, multiple primary; Neoplasms, second primary; Stomach neoplasms.

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Conflict of interest statement

No potential conflict of interest relevant to this article is reported.

Figures

Figure 1
Figure 1
Flow chart showing the patient selection process. ESD, endoscopic submucosal dissection.
Figure 2
Figure 2
Annual incidence rates of metachronous lesions after primary endoscopic submucosal dissection (ESD).
See this image and copyright information in PMC

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