Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Abstract

Aims: To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy.

Methods: This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events.

Results: The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6-58 months), there was no recurrence in any case.

Conclusions: ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

Figure 1

Endoscopic submucosal dissection for early gastric cancer in the gastric conduit, after esophagectomy. (a) A slightly depressed lesion is observed in the gastric conduit. (b) Circumferential marking is performed around the tumor using argon plasma coagulation. (c) A circumferential mucosal incision is made outside the marking dots with an electrosurgical knife. (d) Submucosal dissection is performed with an electrosurgical knife. (e) The lesion is completely removed. (f) Resected specimen.

Figure 2

Flowchart of the patients included in the study.