Efficacy of Endoscopic Mucosal Resection with Suction in the Treatment of Gastric Adenoma

Abstract

Efficacy of Endoscopic Mucosal Resection with Suction in the Treatment of Gastric Adenoma Jae G. Kim, Hyung Joon Kim, Bong Gi Cha, Jae Hyuk Do, Sae Kyung Chang, Sill Moo Park Endoscopic mucosal resection with suction (EMR-S) is an established treatment option for gastric adenoma. The EMR-S is broadly divided into 2 categories by technical aspect, which are endoscopic mucosal resection with ligator device (EMR-L) and endoscopic mucosal resection with cap-fitted endoscope (EMR-C). The aim of this study was to clarify the efficacy and limitation of EMR-S for the resection of gastric adenoma.Methods: To compare the EMR-L and EMR-C, we studied the size of lesion, location, macroscopic finding and complete resection (CR) rate according to resection technique. Between June 1996 and June 2003, 32 gastric adenomas in 27 patients that were diagnosed by endoscopic biopsy were resected with EMR-S. The patients were classified into three groups, which were EMR-L (n=16), EMR-C with single channel endoscope (EMR-C1, n=9) and EMR-C with double channel endoscope (EMR-C2, n=7). Results: Overall complete resection rate of EMR-S was 90.6% (29/32). Two of 3 incomplete resected cases were vertically invaded to submucosal layer. The other case was laterally invaded. CR rate according to location was lowest in the post-wall side of body. No difference of CR rate was noted with regard to the macroscopic finding. The average size of the resected specimens were 8.5 6 3.9 mm in EMR-L, 12.5 6 3.2mm inEMR-C1 and 15.06 6.0mm inEMR-C2. The size of resected specimens was significantly larger in EMR-C2 than EMR-L and EMR-C1 (p<0.05). No serious complication was encountered. Conclusion: EMR-S is effective and safe for the treatment of gastric adenoma. The lesions less than 21mm in maximal diameter can be resected by EMR-C2. *M1805 Metastatic Tumors to the Stomach: Analysis of 83 Patients Diagnosed by Endoscopy Noriko Sakemura, Takuji Gotoda, Takahisa Matsuda, Hisanao Hamanaka, Ichiro Oda Background: Metastases to the gastrointestinal tract are considered unusual site for malignant tumors. There have been a few published reports on metastatic lesions to the stomach about endoscopic findings. We investigated endoscopic features of metastatic tumors to the stomach from distant sites. Patients and Method: We used retrospectively entered database (from 1968 to 2002) to identify all patients with metastatic tumors to the stomach, which were detected endoscopically at the National Cancer Center Hospital in Tokyo. Patients with leukemia, malignant lymphoma with gastric involvement, or gastric invasion directly from neighboring organs, were excluded from this study. Results: The primary sites were as followings; lung (18cases, 22%), malignant melanoma (17cases, 20%), breast (16cases, 19%), esophagus (16cases, 19%), and the others (head and neck; 4, ovary; 3, uterus; 2, testis; 2, biliary tract; 1, kidney; 1, and unknown; 3). Among 83 cases with metastatic tumors to the stomach, 49 cases (59%) had solitary gastric lesion and the rest 34 cases had multiple lesions (41%). Seventy-six cases (92%) of the metastatic tumors were located in the middle or upper third of the stomach. In the endoscopic appearance, 41 patients had lesions resembling submucosal tumor. Twenty-eight patients, including 4 patients with Borrman 4 like formation, had tumors resembling primary gastric cancer. Three of four cases looked like Borrman 4 gastric cancer were from breast cancer. In all cases with malignant melanoma, small black dots were recognized. Conclusions: When we faced the features mentioned above at endoscopic examination, metastatic tumor to the stomach should be considered as a differential diagnosis.