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. 2025 Jul 16;17(7):107911.
doi: 10.4253/wjge.v17.i7.107911.

Impact of gastric neoplasms location on clinical outcome of patients treated by endoscopic submucosal dissection

Josué Aliaga Ramos  1   2   3 , Vitor Nunes Arantes  4   5   6
Affiliations

Impact of gastric neoplasms location on clinical outcome of patients treated by endoscopic submucosal dissection

Josué Aliaga Ramos et al. World J Gastrointest Endosc. .

Abstract

Background: The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection (ESD). There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.

Aim: To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.

Methods: A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024. Patients were stratified into two groups based on tumor location: Group 1 included patients with tumors in the lower third of the stomach, while Group 2 included those with tumors in the middle or upper third. The following parameters were evaluated for each group: procedure duration, curative resection rate, en bloc resection rate, complete resection rate, incidence of complications, and depth of neoplastic invasion.

Results: The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach (P = 0.0011). En bloc resection rates for ESD in the distal and proximal stomach were 97.9% and 85.7%, respectively (P = 0.0016), while complete resection rates were 93.9% and 73.4%, respectively (P = 0.0002). Curative resection was achieved in 90.9% of distal lesions compared to 65.3% of proximal lesions (P = 0.0001). Submucosal invasion was identified in 4.0% of distal lesions and 14.2% of proximal lesions (P = 0.013).

Conclusion: ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach, independent of lesion size and histopathological characteristics. Additionally, proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.

Keywords: Adenocarcinoma; Endoscopic submucosal dissection; Gastric topography; Learning curve; Stomach neoplasms.

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Conflict of interest statement

Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Schematic of the location of stomach lesions.
Figure 2
Figure 2
Illustrative pictures of endoscopic submucosal dissection in the lower third of the stomach. A: A 33-year-old woman presented with an elevated-type lesion (0-IIa) in the lower third of the stomach (gastric antrum); B: Markings were placed for endoscopic submucosal dissection, mucosal incision was started at the distal margin of the lesion; C: Submucosal injection to lift the lesion with 0.4% sodium hyaluronate in a teardrops form; D: Submucosal layer dissection; E: Complete tumor resection was achieved en bloc; F: Histological analysis of the endoscopic submucosal dissection specimen that revealed high grade dysplasia.
Figure 3
Figure 3
Illustrative pictures of endoscopic submucosal dissection in the upper-middle third of the stomach. A: A 33-year-old woman presented with a flat-type lesion (0-IIb) in the upper-middle third of the stomach (gastric body); B: Markings were placed for endoscopic submucosal dissection. Mucosal incision was started at the distal margin of the lesion; C: Mucosal incision; D: Submucosal layer dissection; E: Complete tumor resection was achieved en bloc; F: Histological analysis of the endoscopic submucosal dissection specimen that revealed predominantly undifferentiated (diffuse) mixed-type adenocarcinoma.
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