Abstract
Aims To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.
Highlights
The incidence of gastric cancer in the remnant stomach reportedly comprises 1-2% of all gastric cancers [1]; this incidence has been increasing in conjunction with increasing survival rates following gastrectomy due to gastric cancer
Advances in diagnostic technology and periodic postgastrectomy surveillance have enabled the early detection of gastric epithelial neoplasms (GENs), such as early gastric cancer (EGC) and adenoma
Endoscopic submucosal dissection (ESD) for tumors in the remnant stomach, after partial gastrectomy, is technically difficult because of the limited working space for the endoscopic procedure as well as the presence of severe fibrosis and staples under the suture lines [13]. Such lesions are generally located in the upper third of the stomach, which increases the difficulty of manipulating the endoscope and maintaining a suitable distance and direction between the lesion and the endoscope [10]
Summary
The incidence of gastric cancer in the remnant stomach reportedly comprises 1-2% of all gastric cancers [1]; this incidence has been increasing in conjunction with increasing survival rates following gastrectomy due to gastric cancer. Metachronous gastric cancers occur in 0.6–3.0% of patients who undergo partial gastrectomy [2,3,4]. There is little information regarding the optimal treatment of GEN in the remnant stomach (GEN-RS). Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach [5, 6]. ESD has been considered an effective treatment modality for GEN-RS because ESD can preserve the remnant stomach, leading to better patient quality of life [7]. ESD for GEN-RS, is notorious for its procedural difficulty because of the narrow inner space and the severe fibrosis along the suture lines [8]. Massive postoperative adhesions around the remnant stomach make ESD of the tumors in the remnant stomach more difficult than that of the tumors in the whole stomach [8]
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