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. 2023 Sep;37(9):6877-6884.
doi: 10.1007/s00464-023-10175-x. Epub 2023 Jun 13.

Feasibility of underwater endoscopic mucosal resection for endoscopic management of gastric neoplasms in patients with familial adenomatous polyposis

Yusaku Shimamoto  1 , Yoji Takeuchi  2   3 , Shingo Ishiguro  4 , Shin-Ichi Nakatsuka  5 , Hiroshi Yunokizaki  6 , Yasumasa Ezoe  6 , Kenshi Matsuno  1   7 , Hiroko Nakahira  1 , Satoki Shichijo  1 , Akira Maekawa  1 , Takashi Kanesaka  1 , Sachiko Yamamoto  1 , Koji Higashino  1 , Noriya Uedo  1 , Ryu Ishihara  1 , Hideki Ishikawa  6   8
Affiliations

Feasibility of underwater endoscopic mucosal resection for endoscopic management of gastric neoplasms in patients with familial adenomatous polyposis

Yusaku Shimamoto et al. Surg Endosc. 2023 Sep.

Abstract

Background: Underwater endoscopic mucosal resection (UEMR) has been developed as an effective endoscopic intervention for colon, rectum, and duodenum neoplasms. However, there are no comprehensive reports regarding the stomach, and its safety and efficacy are unknown. We aimed to examine the feasibility of UEMR for gastric neoplasms in patients with familial adenomatous polyposis (FAP).

Methods: We retrospectively extracted data of patients with FAP who underwent endoscopic resection (ER) for gastric neoplasms at Osaka International Cancer Institute from February 2009 to December 2018. Elevated gastric neoplasms of ≤ 20 mm in diameter were extracted, and conventional endoscopic mucosal resection (CEMR) and UEMR were compared. Furthermore, outcomes after ER until March 2020 were examined.

Results: 91 endoscopically resected gastric neoplasms were extracted from 31 patients with 26 pedigrees, and 12 neoplasms underwent CEMR and 25 neoplasms underwent UEMR was compared. The procedure time was shorter for UEMR than for CEMR. There was no significant difference between en bloc resection and R0 resection rates by EMR methods. CEMR and UEMR showed postoperative hemorrhage rates of 8% and 0%, respectively. Residual/local recurrent neoplasms were identified in four lesions (4%), but additional endoscopic intervention (three UEMR and one cauterization) resulted in a local cure.

Conclusion: UEMR was feasible in gastric neoplasms of FAP patients, especially in elevated lesions and those of ≤ 20 mm in diameter.

Keywords: Endoscopic management; Familial adenomatous polyposis; Gastric neoplasms; Underwater endoscopic mucosal resection.

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