Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms

Abstract

Aim: To investigate the feasibility and safety of secondary endoscopic submucosal dissection (ESD) for residual or locally recurrent gastric tumors.

Methods: Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups.

Results: The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD (78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group (10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD.

Conclusion: Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.

Keywords: Endoscopic submucosal dissection; Gastric neoplasms; Recurrent tumors; Residual tumors; Secondary endoscopic submucosal dissection.

Figure 1

Case of early salvage endoscopic submucosal dissection. A 52 year old female patient was diagnosed with a 6 cm early gastric cancer on the posterior wall of the lower body. The primary ESD procedure was performed, and en bloc resection was achieved. The pathology report indicated the positive lateral margin. Early salvage ESD was performed after histological confirmation of positive lateral margins of the initial ESD specimen. ESD: Endoscopic submucosal dissection.

Figure 2

Case of late salvage endoscopic submucosal dissection. A 52 year old male patient was diagnosed with a 3 cm early gastric cancer on the posterior wall of the lower body. The primary ESD procedure was performed, and piecemeal resection was done incompletely due to severe bleeding and adhesion. Late salvage ESD was performed after complete healing of the artificial ulcer caused by the primary ESD. ESD: Endoscopic submucosal dissection.

Figure 3

Case of late secondary endoscopic submucosal dissection. A 61 year old male patient was diagnosed with a 1.7 cm high grade dysplasia on the lesser curvature of the angle. The primary ESD procedure was performed, and en bloc resection was achieved. The local recurrence was shown five years after initial curative primary ESD. Late secondary ESD was performed. ESD: Endoscopic submucosal dissection.