7062 A clinical study on protruding lesions that arise at the scar of endoscopic mucosal resection for early gastric carcinoma and gastric flat adenoma.

Abstract

Background:Several studies of EMR have been reported, but reports about benign protrudinglesions that arise at the scar of EMR for early gastric cancer (EGC) or gastric adenoma are rare. Aim: To elucidate endoscopic and histologicalcharacteristics of benign protruding lesions which arise at the scar of EMR for EGC and gastric flat adenoma. Methods and Materials: In 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases which were completely resected by endoscopy and which could be followed-up, we analyzed endoscopic findings which included initial and protruding lesions, and several other clinical factors (H. pyloriinfection, eradication therapy, and Proton pump inhibitor (PPI) or H2-blocker use). We analyzed, retrospectively, 16 lesions that arose at the scar of EMR. Results: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~). 1 of 28 EGC (3.6%), and 15 of 73 gastric flatadenoma (20.5%) arose at the scar of EMR. All of the patients were men (mean age 53 years). 2. With respect to the endoscopic findings, the shapes of protruding lesions were as follows; 10 Yamada(Y) I, 4 Y-II, 1 Y-III, 1 flat lesion. Histologicalexamination of protruding lesion revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6, respectively.With respect to the location of primary lesion, 18.2 % of the protruding lesions developed in the antrum, 19.2% in thelower body, and 20% in the midbody, respectively (p>0.05). 3. There was no difference incidence of developingprotruding lesion in size, depth of invasion and resection method of primary lesion. However, incidence of those lesions was higher in cases of tubular adenoma with focal high grade dysplasia than tubular adenoma without dysplasia (p<0.05). 4. The incidence of H. pyloriinfection was higher in patients (81.7%) who developed a protruding lesion than (51.8%) who did not developed (p=0.029), and also higher incidence of use of PPI in those patients (p=0.045). But, eradication therapy of H. pylori, duration of use of PPI or H2-blocker showed no difference in between groups. Conclusions: It may be possible that the potential hyperplasia thatmay reside in normal mucosa surrounding EGC or gastric adenoma might wake up during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pyloriand PPI might be also related to develop the protruding lesions. Background:Several studies of EMR have been reported, but reports about benign protrudinglesions that arise at the scar of EMR for early gastric cancer (EGC) or gastric adenoma are rare. Aim: To elucidate endoscopic and histologicalcharacteristics of benign protruding lesions which arise at the scar of EMR for EGC and gastric flat adenoma. Methods and Materials: In 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases which were completely resected by endoscopy and which could be followed-up, we analyzed endoscopic findings which included initial and protruding lesions, and several other clinical factors (H. pyloriinfection, eradication therapy, and Proton pump inhibitor (PPI) or H2-blocker use). We analyzed, retrospectively, 16 lesions that arose at the scar of EMR. Results: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~). 1 of 28 EGC (3.6%), and 15 of 73 gastric flatadenoma (20.5%) arose at the scar of EMR. All of the patients were men (mean age 53 years). 2. With respect to the endoscopic findings, the shapes of protruding lesions were as follows; 10 Yamada(Y) I, 4 Y-II, 1 Y-III, 1 flat lesion. Histologicalexamination of protruding lesion revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6, respectively.With respect to the location of primary lesion, 18.2 % of the protruding lesions developed in the antrum, 19.2% in thelower body, and 20% in the midbody, respectively (p>0.05). 3. There was no difference incidence of developingprotruding lesion in size, depth of invasion and resection method of primary lesion. However, incidence of those lesions was higher in cases of tubular adenoma with focal high grade dysplasia than tubular adenoma without dysplasia (p<0.05). 4. The incidence of H. pyloriinfection was higher in patients (81.7%) who developed a protruding lesion than (51.8%) who did not developed (p=0.029), and also higher incidence of use of PPI in those patients (p=0.045). But, eradication therapy of H. pylori, duration of use of PPI or H2-blocker showed no difference in between groups. Conclusions: It may be possible that the potential hyperplasia thatmay reside in normal mucosa surrounding EGC or gastric adenoma might wake up during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pyloriand PPI might be also related to develop the protruding lesions.